Funding Request Form

Funding Request Form
Date of Request*

MonthDayYear
Date
Name*

First NameLast Name
Full Mailing Address (Street, City, State, and Zip)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Student Status*

Full-Time StudentPart-Time StudentOther
Are you currently an employee of Alvernia University?*

YesNo
Please enter the email address of your Department Chair, Faculty Research Advisor, or Dissertation Chair*
Enter the Department and the Degree that you are currently pursuing.*
example@example.com
Academic year of your request.*
Request Type (Research Support, Conference Attendance Support, etc.) Please be as detailed as possible.*
Amount of Request*
Project Name or Event Title*
Overview/Summary of Project or Event
Provide a detailed rationale of the relevance of this project as it relates to your development as a student in pursuit of career goals. How will this project/activity contribute to your evolution as a student and future professional? Summarize the project and identify the expected outcome(s). Explain how this project fits in with your own long-range professional development plans. *
Impact
What do you expect to learn and/or what skills do you expect to develop. Describe any plans to “share” newor enhanced knowledge with others.*
When you have completed this segment of your project, how will you evaluate the experience, especially the achievement of the project objective? *
How will the effectiveness of your project be assessed by peers?*
Timeline
Include a timeline of what will be completed and when and how it fits into a larger project (if applicable).*
Budget
Detailed summary and justification of the budget needed to complete the project or attend the event. If support is requested for travel, you must provide complete details of proposed travel – dates, location, and purpose.

Example:
- Flight: $400.21 (Roundtrip flights from PHL to MCO on 3/11/24, returned on 3/13/24)
- Food: $30.20 (see attached receipts)
- Gas and Rental Car: $120 ($20 for gas, rental car $50 a day for 2 days)
- Conference Fee: $200
Please upload all relevant receipts. This can include hotels, flights, transportation, and conference registration fees, etc. Please be aware that invoices do not count as receipts.

Cancelof
By selecting 'yes', you understand that funding requests are for reimbursement only, and that the GSA and Alvernia University cannot approve any requests without receipts nor for future events.*

YesNo
Should be Empty:

Funding Request Form

Overview/Summary of Project or Event

Impact

Timeline

Budget