IEEE PES – WIP Funding Request Form | IEEE PES Women in Power

This form is to be used for Special Funding requests for IEEE PES Women in Power.

Name*

First Last

IEEE Membership Number: *

Email address: *

Phone Number:*

IEEE PES WIP Volunteer position: *

Title of Activity:*

Date of Activity:*

Description of Activity: *

Provide details of the activity (1000 words or less). Include information such as objectives, audience, alignment with IEEE PES Women in Power mission/vision, benefits to our community, etc. Mention the importance of the activity

Total Number of Participants Expected:*

Please enter a number from 1 to 3000.

Number of IEEE Members: *

Please enter a number from 0 to 3000.

Number of Non-members: *

Please enter a number from 0 to 3000.

Identify Other sources of funding solicited. Include sources and amounts requested. *

Amount of WIE funding requested:*

Please enter a number from 0 to 1000000.

Please send the required Budget Plan document send to [email protected]

Provide Section Treasurer (Name/Contact Information):

Wire Transfer Information (WIE Affinity Group Transfer):

Bank Name:*

Bank Address: *

City: *

Country/Region*

Bank Acct Name: *

Bank Acct or IBAN#: *

Instructions for Wire: *

Concentration Banking Account Number: *

Internal GL Account Number (Society Transfer):*

Name

This field is for validation purposes and should be left unchanged.

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