*Today's date (MM/DD/YYYY):

Event Description

*Event type:

*Event location:

*Event date:
NOTE: Applications must be submitted at least one week PRIOR to the event

*Event time:

*Amount requested ($250.00 maximum):

Applicant Information

*Applicant's academic status:

Faculty

Undergraduate student

Teaching assistant

*Employee or SID number. (Do not enter your social security number.):

*Applicant name (first and last):

*Applicant e-mail:

*Applicant phone (include area code):

*Address (STREET, CITY, ZIP):

Department (Please do not use abbreviations.):

Academic course title (if applicable):

Course selection number:

Additional Information

*Number of faculty attendees:

*Number of teaching assistant attendees:

*Number of undergraduate attendees:

Please identify event guest(s). For large group events at which all guests may not be identifiable, please provide three names from the guest list. If you're inviting fewer than three guests, write "NA" in the "Guest 2" and "Guest 3" fields.

*Faculty guest 1:

*Guest 2:

*Guest 3:

Guest 4:

Guest 5:

Guest 6:

How did you hear about the Dean Witter Fund?