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2. Human Rights Commission Request for Funding
   The City of Eugene allocates funds each fiscal year to the Human Rights Commission (HRC) to use to support community events. Applications must be submitted complete with a full explanation of the funding request. All requests must be submitted 10 days prior to the HRC meeting (3rd Tuesdays) in advance of the event or project start date. Timely submission assures that requests are discussed and approved for funding. Having a representative at the HRC meeting to answer questions about the request is strongly encouraged. Please note that if funding is approved, the commission requires a follow-up report within 30 days of the event. Recipients may submit a written report or may attend the next commission meeting to present a brief verbal report. Photos are encouraged but not required. Failing to provide a report may result in denial for future funding.
4. Date of Event
   Date of Event
5. Date Funding Required
   Date Funding Required
7. Please describe the event/activity for which you are requesting support and/or funding*
9. Level of Support Requested*
   -- Select One --Endorsement: no funding but endorsement for use on advertising and outreachSupport: up to $100 for event where HRC is not directly involved Co-sponsorship: up to $200 for event with HRC involvementMore than $200: special circumstances with active HRC involvement

   Please indicate which level of support that is being requested:
10. How much is the request for? *
    Enter 0 if this is just a request for support
12. Name of Support and/or Funding Recipient
14. Organization (if applicable)
16. Applicant's First Name*
17. Applicant's Last Name*
19. Address (for mailing check)*
21. City*
22. State Name*
23. ZIP*
25. Email*
26. Phone*
27. Extension
29. Payment should go to:*

    1. Organization Listed
    2. Individual Listed

    1. Not a funding request
31. How does this request align with the work of the Human Rights Commission? What will these funds be used for specifically (if applicable). *
33. Who are the other community partners and what is their level of involvement?
35. Is this event:*

    Commission bylaws require that events it sponsors must be fully accessible. Facilities should meet Americans with Disabilities Act standards and sign interpretation should be provided if requested. Both wheelchair access and the availability of interpretation should be included in advertisements for the event.

    1. Wheelchair Accessible?
    2. Open for language interpretation if needed?
    3. Accessible for hearing impaired?
    4. Strictly a fundraising event?
    5. Open to the general public?
    6. Not applicable
37. I acknowledge that by receiving funding to support this event that I am responsible for providing a brief report back to the HRC within 30-days of the event. Failure to provide this report either in writing or in person at a HRC meeting may result in denial for future funding. *

    1. I understand
39. Electronic Signature
    By providing the information below and electronic signature, I certify that I have read and understood the submittal requirements outlined, and that I understand that omission of any listed item may cause delay in processing the application. I (We), the undersigned, acknowledge that the information supplied in this application is complete and accurate to the best of my (our) knowledge.
41. I am the:

    1. Applicant

    1. Applicant's Representative
43. Full Name of Applicant representative
44. Email of applicant's representative
46. Electronic Signature*

    1. Sign

    By checking this box, I am providing an electronic signature.
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field