Request for CPL Funds

Name:
Address:
City:
State/Province:
Zip/Postal Code:
Email:
Date of Event:
Amount of Request:
Check Payable To:
Send Check To:
Are Matching Funds Available (if applicable)?
If necessary, please upload a Word or Text Document With additional information:
Please describe your activity in three or four sentences. Explain how this activity will promote Latin in your community. If appropriate, mention how you plan to publicize this activity. A more detailed description and supporting materials can be attached, if necessary.