Student Activities Safety Association

Funding Application Request Form

Please print this form and return the completed form to:
Geoff Banks (SASA Treasurer) Leeds University Union, PO Box 157, Leeds. LS1 1UH.

Course title:
Scheduled time:
Delivery time:

Details of Course:

Course objectives:
On completion of the Course what will the candidate be able to do

For whom and how many is the course intended for?
E.g. Students/Staff, Club Leaders, Activity Leaders, Universities in the Midlands/Scotland, Prior experience.

Course content:

Breakdown of Costs:

Estimated income:

£ Expected entrance fees:
£ Other funding: Please state
£ Total income:

Estimated expenditure:
Please detail

£ Of tutors/instructors: including travel expenses (please refer to guidance notes)
£ Of travel expenses for helpers/other staff:
£ Resources:
£ Admin:
£ Facilty hire:
£ Accommodation:
£ Equipment hire:
Other: Please state
£ Total expenditure:

£ Difference:
£ How much funding are you requesting and what for?

Contact Details of Course Organiser:

Name:
Address:
Tel:
Fax:
E-mail:

ADMINISTRATION PURPOSE ONLY:

Date received:
Date processed:
Amount of funding awarded and for what:
Authorised:	Treasurer:	Other committee member:	Other committee member: