| Requestor Information: | |
| Requestor's Name: | |
| Requestor's Position: | |
| Supervisor's Name: | |
| Department/Division/Area: | |
| Telephone Number: | |
| E-Mail Address: | |
| Activity / Event / Purchase Information: | |
|
Describe the activity / event / purchase for which funding is being requested. |
|
| How will the activity / event / purchase help you achieve your diversity goals? | |
| How does this activity relate to the mission statement of the SCC Diversity Committee? | |
| If planning an event or activity, when will it occur? | |
| Where will the event or activity take place? | |
| Budget Information: | |
| Amount of funds being requested? | |
| If approved, to what account number should funds be transferred? | |
| Please provide below an itemized budget describing how the funds will be used. |
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