Funding Request Form

All fields are required. Incomplete forms will not be considered.

Requests for funding from the New York State Affiliate should not be considered all-inclusive and completing the Funding Request Form does not guarantee you will receive the funds you are requesting. While every effort will be made to provide assistance from the State Affiliate, these funds should be considered secondary to any assistance offered by your Chapter as well as your personal contribution.

Requests for funding are due six weeks prior to the start of the event, unless an alternative deadline has been publicly announced. Expenses will not be authorized after the event takes place.

Personal Info

Personal Information

First Name First Name

Last Name Last Name

Telephone Telephone

Email Email

Street Address Street Address

Please include Apt number.

City City

State State

Zip Zip

Five-digit code.

Chapter/Division Chapter/Division

In a few words, tell us about your activity with the Federation. In a few words, tell us about your activity with the Federation.

Event Info

Event Information

Event Event

Have you requested funding for this event from your chapter? Have you requested funding for this event from your chapter?

Briefly Explain Why No Chapter Request Was Made Briefly Explain Why No Chapter Request Was Made

Has the chapter made it’s decision regarding that funding request? Has the chapter made it’s decision regarding that funding request?

How much funding will you receive for this event from your chapter? How much funding will you receive for this event from your chapter?

Instructions2

State funding for National Federation of the Blind events will be granted up to three times annually for any individual. The only exception to this policy will be the current affiliate president or their designee, approved by the majority of the executive board.

Have you received state funding for any other National Federation of the Blind event(s) this calendar year? Have you received state funding for any other National Federation of the Blind event(s) this calendar year?

Which event(s)? Which event(s)?

Event Start Date Event Start Date

Event End Date Event End Date

Arrangements

Travel and Accommodation Arrangements

Request Details Request Details

(Detailed description of expenses you are requesting be covered.)

Total Amount Requested Total Amount Requested

How much, in total, are you requesting? Enter only numbers with no cents.

Additional Information

Travel reimbursements are calculated for bus, train, or best-value airline, unless otherwise arranged in advance. The per diem rate is set at $60, to cover meals, incidental expenses, and ground transportation.

Conditions and Agreement

I understand that this request, if granted, may be fulfilled in whole or in part. I also understand these requests are due by a set deadline and requests received after that deadline may not be considered. Special circumstances may be brought to the President or the Executive Board for consideration on a case-by-case basis.

I understand and agree to the following:

If funding is granted for state or national convention, I agree to register, either online or upon arrival.
If attending National Convention, I agree to attend the board meeting, the resolutions committee meeting, the six general sessions, our affiliate caucus and the banquet.
If attending state convention, I agree to attend the board meeting, hospitality night, all three General sessions, and the banquet.
I will represent the Federation with professional appearance and behavior at all times.
I understand that I may be asked to support the affiliate in a variety of ways during the event for which I am requesting funding. This may include participating in fundraisers, marshaling, setting up events, etc.

Receipts are to be provided within 30 days of the end of the event. Failure to provide receipts will disqualify me from future funding. Receipts for hotel and travel expenditures are required for reimbursement. Per Diem funding does not require receipts.

Unused funds must be returned to the affiliate. Further, If state funding for the event is granted and subsequently, chapter funding is granted for the same expenses, the funding granted by the state must be returned.

I Agree

I Disagree

Electronic Signature Electronic Signature

By typing your name in this box, and submitting this form, you agree to the requirements outlined above.

Funding Request Form

Funding Request Form

Personal Information

Event Information

Travel and Accommodation Arrangements

Conditions and Agreement

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