Online Application

Name of Student Organization:

Number of participants attending:

Name(s) of Applicant(s):

Ratified Group:

•  Yes
•  No

Affiliation:

•  Undergraduate
•  Graduate

Academic Program:

Email Address:

Telephone Number On-Campus:

Telephone Number Off-Campus:

Mailing Address:

Budget Requested:

Name of Event:

Date of Event:

Event Website (if applicable):

Other Sources Funding:

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Project Description

Please provide a detailed description of the project and delineate the ways in which the project meets the guidelines of the fund.

Please list expenses (i.e. flight, hotel, etc.) or a budget for the event:

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All information requested by the Student Innovation Fund will be used solely for the administration and management of the program. All personal information collected by the Student Innovation Fund Committee is subject to the Access to Information and Protection of Privacy Act. Personal information is collected under the authority of the Memorial University Act (RSNL 1990 Chapter M-7) and is used for the purposes of academic administration, program planning and human resource management. Questions about this collection and use of personal information may be directed to the Office of the Dean, Student Affairs and Services.

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