Student Initiative Fund Application

Given and Surname*

Carleton E-mail Address*

Telephone Number*

Student Number*

Faculty/Program*

Year of Study/Standing*

Social Insurance Number*

Amount Requested*

CUSA will fund a maximum of $500.00 per applicant

Name of the initiative*

Event Location (Full mailing address)*

Start Date of Event* (YYYY-MM-DD)

End Date of Event* (YYYY-MM-DD)

Event Organizer's Name*

Event Organizer's E-Mail Address*

Event Organizer's Phone Number*

Describe the event and your interest in hosting, creating and/or attending it.*

Describe how your participation in this event will benefit the profile and/or community of Carleton University*

Please attach supporting conference/event documentation (pamphlet, itinerary etc.)* Minimum of 1 attachment required

Attachment 1*:

Attachment 2 :

Attachment 3 :

Please attach your Student Initiative Fund Budget*

Additional Information

I hereby declare the information contained in the application to be true and accurate. I understand that any misrepresentation on my part in relation to this application will result in the immediate withdrawal of support from CUSA.

I Agree

I agree to provide CUSA with receipts upon request from the conference/event for which funding is granted. I further agree that failure to do so will result in the immediate withdrawal of all CUSA funding causing me to be indebted to CUSA for the amount of the funding provided.

I Agree

I agree upon approval of my application I will write a short description (3 sentences) of my experience before receiving the allocated funding.

I Agree