Hillel - Program Request Form

Your Name (First Last)	Phone Number
(if applicable) Your Username:
Your Campus	E-mail Address
Program Title	Date (MM/DD/YYYY format please) Time
Location	Expected attendance
Sponsoring Group/Committee/Individuals

Supporting Staff Member

Description of Program:

Who is the targeted audience for this program?

Program Goals (What do you hope to achieve? What do you want participants to take from the program? How will you know your program was successful?):

Short term:

Long term:

Possible co-sponsors for the program/event (list contact names and emails as well)
Name	Email
Name	Email
Name	Email
Name	Email

Describe your marketing plan and timeline (examples: banner space, facebook, phone tree,
announcements at BBQs, flyers (location location location!), more ideas available):

Tasks to be completed	By Whom	When
1.
2.
3.
4.
5.
6.
7.

List specific food and supply needs, including amounts where appropriate:

Budget
Expenses (add specific details)		Amount
Food	$
Supplies	$
Advertisement	$
Other Publicity	$
Room, setup and fees	$
Transportation	$
Speaker/Talent	$
Giveaways	$
Other	$
TOTAL	$
Anticipated Revenue
Grants	$
Admission Fees	$
TOTAL	$

Will you solicit in-kind donations? If so, what and from whom?

Will you be raising money for a charitable cause? (Y/N)

If so, how much do you intend to raise (net of expenses)?

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Click here to begin again with a blank form:

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