Campus Support Form – Arcus Center for Social Justice Leadership

Name: *

Date: *

Organization (if applicable):

Email: *

Phone: *

Check One: *

Faculty
Staff
Student

Event Location (if other than ACSJL building):

Is this event open to the public?: *

Yes
No

Issue Area(s)

Social Justice Issues Addressed by Proposed Event (Check all that apply): *

Other:

Event Details

Title of your event: *

Date and Time/Duration: *

Provide a detailed description of your event (include speakers, agenda, format, etc.): *

What are the goals, outcomes, and/or action steps for participants?: *

How does this event connect to the ACSJL's work (mission and social justice definition)?: *

How will you share the outcomes with the ACSJL (photos, sign-in sheets, action steps)?: *

What type of support are you seeking from ACSJL?: *

Building use (Please make your request via EMS)
Financial Support
Staff Participation/Support

Building use: Please make your building request via EMS on the portal. If you do not have access, please note the date, time, and room requested here.:

Name of Host/Event Manager: *

Budget (If no funds are requested, please move on to the next section.):

Total amount requested from ACSJL (typical cosponsorships range from $100-$500, please put detailed expenses below):

Expenses (include dollar amount and description for each individual expense):

Funding from other sources (include dollar amount and description for each source of funding that is not ACSJL):

Staff Support

Number of Full Time Staff:

Number of Student Fellows:

Total Hours (est.):

Names of specific staff, if known:

Specific duties asked of ACSJL staff:

Who would you like to do the following tasks? (Please check one for each task)

Contact/confirm speaker arrangements:

ACSJL staff
Host Org/Group (you)

Collect RSVPs:

ACSJL staff
Host Org/Group (you)

Provide/arrange media equipment & furniture set up:

ACSJL staff
Host Org/Group (you)

Create & post flyer (also share electronic copy with ACSJL staff):

ACSJL staff
Host Org/Group (you)

Create & share social media event page):

ACSJL staff
Host Org/Group (you)

Write & distribute press release:

ACSJL staff
Host Org/Group (you)

Conduct outreach to partners:

ACSJL staff
Host Org/Group (you)

Order catering:

ACSJL staff
Host Org/Group (you)

Prepare printed materials/handouts for event:

ACSJL staff
Host Org/Group (you)

Purchase other materials/supplies:

ACSJL staff
Host Org/Group (you)

Take photos at event:

ACSJL staff
Host Org/Group (you)

Collect & distribute evaluation sheet:

ACSJL staff
Host Org/Group (you)

Other duties not listed: