Fillable WAGNER COLLEGE FACULTY STUDENT SUPPORT REQUEST APPLICATION FORM (Wagner College)

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WAGNER COLLEGE FACULTY STUDENT SUPPORT REQUEST APPLICATION FORM (Wagner College)

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WAGNER COLLEGE
FACULTY STUDENT SUPPORT REQUEST APPLICATION FORM
DUE THE SECOND FRIDAY AFTER THE BEGINNING OF CLASSES
The Faculty Student Support request provides a stipend for students in a specific
course to participate in a local event or activity during the academic year that is
related to the course curriculum. These funds serve to underwrite or complement
the cost of this activity. Normally, the total request should not exceed $200.00 per
class, per semester. Applications submitted after the deadline will only be
considered if funds remain in the budget.
Proposal submitted by: ___________________________________________ Date: _______________
Department: ________________________________________________________________________________
Email and extension: ______________________________________________________________________
Did you apply for funding last semester? ____________
Course name and number: _______________________________________________________________
Title of activity: ____________________________________________________________________________
________________________________________________________________________________________________
Date(s): _____________________________________________________________________________________
How will the activity or event enrich the course curriculum? Attach sheet of
paper if necessary:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Estimated number of students participating: ________________________________________
Budget breakdown:
Transportation: __________________________________________
Entrance Fee: ____________________________________________
Other (please explain): _________________________________
TOTAL: _______________
Faculty Signature: _______________________________________________________
Provost Signature: ______________________________________________________
Account Number: ______________________
Revised 8/2020
$
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WAGNER COLLEGE FACULTY STUDENT SUPPORT REQUEST APPLICATION FORM (Wagner College)

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Completed 28 January 2021

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