MALSA Funding Application

Name

Mailing Address

City

State

Zip Code

Telephone numbers(s)

Check Appropriate Boxes

Class

Requesting funding for:

Workshop/Conference

Competition

Other

If other, list sources:

Have you applied for funds from other sources?

SBA

Amount

GPSA

Amount

UNMSOL

Amount

Other

Amount

If other, list sources:

Amount Requested (maximum of $75.00)

Checklist for complete application packet:

Receipts from event

Application form

Outlined budget of total expenditures

One-page statement describing benefits derived from attending event/function

Briefly describe your overall involvement in MALSA, including your participation in at least one MALSA-sponsored event.

Text area for MALSA involvement

Please submit complete application packet to MALSA Treasurer or to any MALSA board member prior to each board meeting.

Signature of Applicant: X______________________________________ Date: ____________