Special Programs Proposal Form

*All starred fields on this form must be completed.

The starred items are required for initial consideration by the Special Programs sub-committee, but please fill out as much as possible. Rough estimates of costs, potential speakers, and suggestions for locations and dates are all helpful. Please indicate whether these are currently only estimates or ideas.

Submission date:*

Date

Title of project:*

Name of person(s) submitting this proposal:

Primary contact:*

First NameLast Name

Phone number:*

Please enter a valid phone number.

Email*

example@example.com

Additional contact:

First NameLast Name

Phone number:

Please enter a valid phone number.

Email:

example@example.com

Description of project (max of 250 words):*

Who is the intended audience?*

Location(s) where the event will be held:

Will you partner with another institution?

YesNo

If so, describe the nature of the partnership:

Participants: speakers, presenters, etc?

Amount of financial support requested from FCLIR:

Granting agencies to which you are applying from support:

Will the event be free, or will there be admission charged? If so, how much?*

Proposed date(s) for the event:*

The dates must be coordinated with the FCLIR calendar.

Estimated Budget:

Fees for speakers, honoraria, etc:*

Space rental:*

Transportation:*

Housing for overnight speakers/participants:*

Food/catering:*

Advertisement/printing:*

Other (please specify):

List any relevant experience you have had in planning this type of event:*

Please attach copies of all supporting documentation (speakers, venues under consideration, etc.)

Please verify that you are human*