M*A*S*H* 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 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 ~$1500Number 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)Please 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.
