SAMPLE CPL FUND REQUEST FORM

CPL Grant Application Form

PART A: To be completed by the APPLICANT

Name:_______________________________________ ___________________Date of Request:____________

Address:_____________________________________ ___________________Date of Event:______________

City, State/Province, Zip/Mail Code:__________________________________E-mail:________________

Amount of Request:___________________ Check payable to:_______________________

Send check to:_________________________________________________________________________________

Are matching funds available? Yes No

Are receipts attached? Yes No Is a budget attached? Yes No

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.
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Send this form, with all attachments, to your CAMWS State/Provincial Vice-President. Thank you very much!

PART B: To be completed by the STATE/PROVINCIAL VICE-PRESIDENT

Is applicant a current member of CAMWS? Yes No (If uncertain contact Susanne (Sue) Newland (newlands@stolaf.edu).

Approved Denied Comments: ____________________________

Date:____________________________ Signature: _____________________________

PART C: To be completed by the REGIONAL VICE-PRESIDENT

Approved Denied Comments: ____________________________Date:____________________________ Signature: _____________________________

PART D: To be completed by the CHAIR OF CPL

Approved Denied Comments: ____________________________Date:____________________________ Signature: _____________________________

PART E: To be completed by the SECRETARY-TREASURER of CAMWS

Check #:________________ Amount:________________ Date Mailed:________________