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To receive funds from the Pellissippi State
Foundation, you must complete the following form and submit it three
weeks prior to the payable funding date. Please review Guidelines for
Requesting Funding before completing this form.
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Name of individual requesting funds
Mr. Mrs.
Ms.
Dr.
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E-mail address (required)
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Phone
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Division, department, office, program or activity for
which funding is requested
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Amount of request ($)
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What percent of the total project cost does this
represent?
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Partial funding may be possible. Please list amounts
needed for separate parts, if applicable.
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Date funding needed
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Date of project(s)
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How does this project support the goals of the
College? Please list specific goal(s) in your response.(See current College
goals)
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Reason for the request (How will the funds be spent?)
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Do you have additional materials in support of the activity that you
would like us to review? If yes, they may be sent to the Foundation Office (see Contact
Us) or described here.
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Were other funding sources solicited for this project?
If yes, please list all other funding sources that were solicited and the
amount requested.
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Name of that administrator who is supporting this
request (president, vice president, associate vice president, department
head, director, or dean)
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Notice to users: the information you submit on this form is being sent
over a secure server. Your privacy is important to us. We will not share
this information with a third party. By giving us your e-mail address you
agree to let us send you information from the Foundation
Office.
