Farm Bureau Fund for Excellence Funding Request MASH Camp Funding Request and Document Submission Form Date(Required) MM slash DD slash YYYY Community Director's Name(Required) First Last Community Director's Email(Required) Is this your first funding request for this MASH/CHAMPS event? Yes No If yes, UAMS Regional Programs staff will be happy to help get the process started. Please provide some information about your camp below.Select the type of camp you are requesting funds for:(Required)Please select one of the following:MASH: Full 2-Week Summer Camp ~$3000MASH: Mini MASH 1-Week Summer Camp ~$2000CHAMPS: 3-5 Day Summer Camp ~$1000Number of students(Required)Please enter the estimated number of students you plan to accept into your camp. Camp Name(Required) Camp Start Date(Required) MM slash DD slash YYYY Camp Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Camp County(Required) List of Vendors -Please list any vendors you typically use or plan to use for lunch, supplies, training materials, etc. UAMS Regional Programs will need to register each company as a vendor. Establishing a company as vendor does not require you to use them if you decide to go with another company, but having your options set up early will help with invoicing later.For each vendor please list the following information if available: company/organization name, contact information (email or phone number), address, and goods and services. If you have an estimate of the expense please provide that in the same space. Company/Organization that check will be issued toContact Information (phone/email/address)Goods & ServicesEstimated cost Add RemovePlease attach camp agenda, final list of accepted students and any other supporting documentation needed for this fund request. If a final list of accepted students is not yet complete, please indicate the approximate number of participants and submit a final accepted participant list at a later date. *Please do not attach W9 or Vendor forms, or any documents that list protected financial information. Email directly to Sheila Williams at sswilliams@uams.edu. Drop files here or Select files Max. file size: 15 MB. Please list any additional sponsors for your camp. Additional sponsors do not affect funding amounts, but allows us to recognize sponsors in publications and social media.If this is not your first funding request for a MASH/CHAMPS event, and you are submitting documents and/or invoices for training materials and/or lunches/refreshments, please provide the name of your camp so that we know which event record to apply this request to. Attach documents and invoices below and give a brief description of the attachments.Camp Name(Required) List of Vendors -Please list any vendors you typically use or plan to use for lunch, supplies, training materials, etc. UAMS Regional Programs will need to register each company as a vendor. Establishing a company as vendor does not require you to use them if you decide to go with another company, but having your options set up early will help with invoicing later.For each vendor please list the following information if available: company/organization name, contact information (email or phone number), address, and goods and services. If you have an estimate of the expense please provide that in the same space. Company/Organization that check will be issued toContact Information (phone/email/address)Goods & ServicesEstimated cost Add RemovePlease attach invoices here: Drop files here or Select files Max. file size: 15 MB. Please provide a brief description of the attached invoice(s).
