A4 Application for Financial Assistance

 Date of submission:

 Name and Brown graduation year:

 Preferred email address:

 Preferred phone number:

 Organization affiliation:

 Brief history and objectives of the organization:

 Mission & purpose of the organization:

 Brief summary of project/proposal (Please attach a copy of a full proposal, if necessary):

 What community need does your project/proposal
 address?

 Expected outcome of project/program:

 Approximate number of people expected to benefit
 from
 this project/program:

 Describe services offered to this population:

Describe how this request connects to A4's mission "to encourage and facilitate positive experiences and engagement with the University, to act as a conduit and facilitator to adequately address the needs of the Brown Asian and Asian American community, and to build partnerships with members of the greater Brown community:

 Requested amount: $ _________

Questions:  Please contact

Stephen Chen '04

stephen@alumni.brown.edu