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JAG Funding Request Form

Date Submitted:
Team Name:

Club Captain:
MS: Phone EXT:

Club Co-Captain:
MS: Phone EXT:

Number of Lab Persons:
Number of Non-Lab Persons:
List of Participants/Members

Funding Request

 Registration Fee:  $ 
 Equipment Costs:  $ 
 Other:  $ 
 Explain (for other funding):     
TOTAL:    $ 

Describe your group's activities, plans and schedule, and provide any additional information you may have regarding why your group should be supported by the Jefferson Lab Activities Group:

Questions, comments, and/or concerns should be directed to David Williams and Nina Farrish