Guest Speaker Funding Request Form

Guest Speaker Funding Request Form - Fall 2026
The Medical Humanities (MDHM) Program supports guest speakers for classes that count toward the MDHM minor. Funding amounts depend on course classification:
- Courses offered exclusively as MDHM (as well as MDHM/ENGL 272) are eligible for up to $250 in honorarium support per speaker; faculty may request funding for up to two speakers. Plus, a parking pass.
- Courses that count as electives for the MDHM minor are eligible for up to $125 from MDHM. Courses that originate in a department should request funding from that unit first. MDHM will also cover a parking pass.
- Please note that these funds are meant to support local speakers, and no additional travel funds are available.
- Funding is limited, and we may not be able to support all requests.
*Please note that these funds are meant to support local speakers, and no additional travel funds are available.

Deadline: Monday, August 31, 2026

Notifications will be sent by: Tuesday, September 08, 2026
Faculty Information
Name

First NameLast Name
Email
example@example.com
Department
Course Number
Course Title
Guest Speaker Details
Speaker Name
Affiliation and Title
Proposed Date of Visit
Talk Title or Topic
Brief explanation of how this speaker supports course content
Funding Request
Amount requested from Medical Humanities
Have you requested funding from another source?
If you selected any of the first three options, please provide the following details
Source of funding
Amount requested
Amount approved (if applicable)
Status or additional comments
Should be Empty:

Guest Speaker Funding Request Form - Fall 2026

Faculty Information

Guest Speaker Details

Funding Request