Please fill out this form electronically before printing GSA Lecture ...
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<strong>Lecture</strong> Grant (LG)<br />
Application Form<br />
The following personal in<strong>form</strong>ation is being collected under the authority of Section 13(1) of the Alberta Personal In<strong>form</strong>ation Protection Act (PIPA) to assess your<br />
application. If you have questions ab<strong>out</strong> the use and disclosure of your personal in<strong>form</strong>ation, contact the <strong>GSA</strong> at 780-492-2175.<br />
<strong>Please</strong> Print Clearly<br />
Section A: STUDENT GROUP INFORMATION<br />
Group Name:<br />
Focus and Purpose of Group:<br />
Is your group registered as a graduate student group through Student Group Services in SUB?<br />
□ Yes □ No (if no, please contact Student Group Services in SUB to register)<br />
Section B: CONTACT INFORMATION<br />
Two students from the group will act as official contacts (one primary and one alternate) to the <strong>GSA</strong>. The <strong>GSA</strong> will<br />
contact ONLY these individuals.<br />
Name:<br />
Campus Telephone:<br />
Campus Address:<br />
Alternate Telephone:<br />
E-Mail Address:<br />
Primary Applicant<br />
Alternate Applicant<br />
<strong>GSA</strong> Grants: <strong>Lecture</strong> Grant Application Form Page 1 of 4
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