1.  This is a funding request for $______________________.

2.  Number of GSAS students in group: _____________   Others: _________

3.  List other sources of funding the amounts requested, and the 
    current status of such requests.

                                                     STATUS OF REQUEST
      SOURCE                   AMOUNT                Yes   No   Pending

    ___________________________________________________________________

    ___________________________________________________________________

    ___________________________________________________________________


4.  Please attach a copy of the group's budget for the period for which
    you are requesting funding.  (Failure to supply a budget will 
    result in automatic denial by the GSC.  The budget should include,
    in sufficient detail, your group's income, expenses and the amount
    being request from the GSC.  You are advised to be as detailed and
    specific as possible.)




5.  Signature:  __________________________   Date:  ___________________

    Position:  ___________________________



Submit with Form 1 to the GSC Office.