Student Club Tiered Funding

Club/organization name:
Name
Club officer or advisor submitting form
KCC email
example@example.com
Name(s) of club/organization advisor(s) approving this tiered funding request:
Which tier of funding are you applying for?

Tier III: VOLUNTEERISM

Please provide the following information about the non-profit organization for which your club volunteered.
Name
Phone
Please provide a valid phone numberFormat: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Type of volunteer work
Event/activity name
Event/activity date

MonthDayYear
Event/activity description
How do you plan on using this funding?

Names of club members and advisors who participated in this event/activity.
To qualify, at least three club members must be currently enrolled KCC students or alumni.

To print your form, choose Print BEFORE submitting.
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