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Community Outreach Grant

Application for Funding

Please complete application and email communityoutreach@evms.edu at least 30 days prior to your project or activity. Please also attach a budget outlining all the costs of the activity and event and amount you hope the grant to fund. Applications submitted without a detailed budget will be denied funding.

Contact Information:

Student Name:

Student Organization/ Program/ Club:

Please specify your organization/program/club:

Faculty Advisor/ Project Contact:

Student Email:

Student Phone:

Project/Activity Information

Project/Activity mission/purpose:

Funding Information

Is the project/activity:

Please specify:

Project/Activity Name:

Project/Activity Dates:

Start Date:

Stop Date:

Location:

Please use the space below to describe how the project or activity plans to utilize grant funds (please attach a separate page if additional space is required):

How does this event align with Community Outreach and the mission and values of EVMS?

* must provide value

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What are the short term outcomes/impact?

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How many individuals/participants do you anticipate your project will impact?

Please detail your COVID-19 plan:

(click here to read the lastest in COVID-19 regulations at EVMS)

* must provide value

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Total funding needed for organization/event:

* must provide value

Total funds requested from Community Outreach Grant:

* must provide value

Please attach your budget breakdown for requested funds:

* must provide value

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Please list other sources of funding for your project/activity (fundraising efforts, existing class funds, etc.):

* must provide value

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Please attach your project budget (if applicable):

Upload file

Please attach your project budget justification (if applicable):

Upload file

Is this a recurring event or activity (annually, semi-annually, new event, etc.)?

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Applicant Signature

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Add signature

Signature Date:

* must provide value

M-D-Y

Internal Use Only

Date Received:

Received By:

Application Decision:

Funding Amount Approved: $

Assistant Director of Community-Engaged Learning:	Date:
Assistant Director of Student Affairs:	Date:

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