PROF Funding Request Form

Report Acknowledgement

All funding requests that are approved require a follow up report from the event within 6 months of the event date. This is to ensure we continue to fund events that align with our division’s goals and the needs of our members. Please acknowledge that you will complete a follow up report by selecting yes below. *

Yes

Requestor Organization/Contact Information

Organization Name *

Contact Name *

Email Address *

Phone *

Is the requestor an ACS division, committee, or local section? *

ACS Division, Committee, or Local Section name *

Is the requestor a member of the Division of Professional Relations? *

Neither of the last two questions were answered with a yes, therefore please provide the name and contact information of the PROF member sponsoring this funding request. *

Event Information

Event/Program Name *

When will this event be held? *Please be specific as possible, including at minimum the month and year.

Is the event part of an ACS-sponsored national or regional meeting? *

Yes, please list meeting details below.No

ACS Meeting Name/Info *Please provide more information on the ACS National or Regional meeting where the event will take place.

Please provide a short description of the event or program. *

Please list all confirmed cosponsors of the event or program.

Please list any potential cosponsors that could be included in the event or program.

Budget Requests and Alignment with PROF

What funds are requested with this sponsorship? *

USD

How will the funds be used to support the event? *

In what ways will PROF be promoted at the event if support is provided? *Examples include membership recruitment, acknowledgment in event program, opportunity to speak at event, etc.

Please briefly describe how the event aligns with the Division’s strategic goals as outlined in the graphic above. *