Community Care Fund Request Form :: Office of Community Care & Institutional Transformation

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Date

Who is the main contact for the request?*

First Last

Please Identify what your request for funds will be used for

Administrator/Exempt Staff
Classified Staff
Faculty

Phone*

Department/Program*

Bellevue College Email*

Enter Email Confirm Email

What date is the proposed event?*

What is the desired duration of the event (Start and Stop)?*

Proposal Title and Purpose of Community Care Funding Request. Please Include the intended impact of program, event, or initiative. The Community Care Fund can not provide funding support for food or beverages.)*

What activities/strategies will you use to achieve the advancement of cultural engagement and learning?*

Please identify which of the goals will be addressed within your hour(s) of service.

Focus on the student’s experience to develop and promote support services/programs while growing, diversifying, and shaping our student body.
Develop an educational community of anti-bias learning that adapts its goals and principles to the specific needs of learners.
Create positive learning environments that are safe, supportive, and engaging.
Partner with (local, regional, state, national, global) communities to enhance the social, economic, and cultural well-being of our campus

Please indicate how the funds requsted will be used (Type of Event)

Art Performance/Cultural Experience Event
Training/Development Event
Social Gathering/Celebration Event
All of the Above
Other

Please indicate where the event will be held

Social Justice Center
Bellevue College Classroom/Workshop Space/Library
Off Campus
All of the Above
Other

In the Type of Event Section above, if you selected "Other", please briefly describe your event.*

Target Audience (check all that applies)*

Students
Faculty
Classified Staff
Administrators

Anticipated Number of Attendees*

Requested amount?

All funding requests are expected to provide a service to the college that is accessible to everyone. This service may be covered within the event itself, if held on Bellevue College grounds or the surrounding Bellevue community. Those individuals requesting professional development funds will have to provide explanation of a workshop/training/community service/office support/etc. that will account for the service to the college.

Does your request exceed $3,000?*

No
Yes

If a request exceeds $3,000, additional review or information may be required. Please permit three – four weeks of advance notice so that all applications may receive proper review. The Office of Community Care and Institutional Transformation (OCCIT) will make every effort to respond to requests in a timely manner.

Three – Four Week Planning Required*

Yes, I confirm I’m planning beyond six weeks to allow sufficient time for a committee to form and decide on this proposal.

Who is sponsoring and/or collaborating with the event?*

Write a contact’s name for each sponsor or collaborator.

Time

:

Time

:

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First Choice
Second Choice
Third Choice

Community Care Fund Request Form

Community Care Form