Civic Engagement Fund Distribution Request

CEF Fund Distribution Request

Gephardt Staff Member Name

Grant ID (fund name, semester (FA/SP), year, grant number, ex: smallchangeSP20201) *

Amount of Funds to be Distributed (please list full amount of award and amount to be distributed with timeline) *

First Name of Primary Grant Contact *

Last Name of Primary Grant Contact *

Email Address of Primary Grant Contact *

Phone Number of Primary Grant Contact *

First Name of Secondary Grant Contact

Last Name of Secondary Grant Contact

Email Address of Secondary Grant Contact

Payment Type * Payment Type

Type of Reimbursement

Individual

Department

Individual Name, Student/Employee ID, and Address

Department Name and Department Billing Number

If Department Reimbursement, Please Provide The Name, E-mail, and Phone # for Departmental Accounting Contact

Project Title

Additional Info

Please upload any additional information here (rosters, grant proposal, etc.).

Maximum upload size: 51.2MB

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