Theme Year Mini Grant Request Form

The Augustana Student Association will use this form to evaluate and allocate funds for organizations taking part in the International Theme Year.

Please be accurate and complete in filling out this application so that a decision
can be reached in a timely manner. The ASA Treasurer will contact you upon review of the request.

Organization Name

Organization Leader

Your Name

Box Number

Phone Number

Your Email Address

Funding Cycle

Please select the Funding Cycle that you are applying for.

Requested Amount to be Provided $

May request up to a maximum of $500.

Summary of the Activity

Please provide a statement of rational and a brief description of the program (2-4 paragraphs).

How will the funds be used?

Please submit a brief explanation of how funds will be used.