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Shasta College DSN Funding Request Form
If funding is available and relevant to the mission of Doing What Matters for Jobs and the Economy, requests will be reviewed by the DSN. These requests will be reviewed on a case-by-case basis.
Name
*
First
Last
Email
*
Phone
*
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Activity Description:
Industry Sector, Please select one:
*
Advanced Manufacturing
Agriculture
Small Business
Activity
Please select
Student Support (i.e. field trips, leadership activities)
Professional Development (faculty, industry or students)
Curriculum Development & Improvement
Career Pathway Exploration (i.e. internships, work-based learning)
Other
Starting Date of Activity
*
MM
/
DD
/
YYYY
Ending Date of Activity
*
MM
/
DD
/
YYYY
Description of Project:
*
Please, no more than 200 words
Total Activity Amount:
*
$
Dollars
.
Cents
Budget Breakdown
Travel Expenses
$
Dollars
.
Cents
Supplies
$
Dollars
.
Cents
Registration Fees
$
Dollars
.
Cents
Service Fees / Stipends
$
Dollars
.
Cents
Is there currently funding allocated for these activities?
Yes
No
Have you previously received funding from your DSN for this specific activity?
Yes
No
**Pending activity approval, upon completion of the activity(s) the funding requester is required to submit an summary of activities and/or project outcomes to the funding DSN.
Signature
*
Clear
