Speakers Series Grant

Applicant's Legal Name(Required)

First Last

Preferred First Name

Email(Required)

Phone(Required)

Short Response Questions

Question 1: Who would you like to bring to Grounds? Please provide a few sentences about their work and what they would talk about. If possible, please provide a link to any speaking materials they have provided.(Required)

Question 2: What is the set of things the speaker would do / talk about? (E.g. a screening, a dinner discussion, a lecture, etc)(Required)

Question 3: What is the student audience you are targeting with this speaker? What organization(s) are you working with to bring this speaker to Grounds?(Required)

Question 4: Have you reached out to Carissa Temerson at the LGBTQ+ Center about best practice for bringing a speaker on Grounds? If not, please also reach out to Carissa when you submit this form.(Required)

You can reach Carissa at uqg6cf@virginia.edu

Question 5: How much are you requesting? Please itemize as much as possible, including the outcome of any negotiations that have taken place so far regarding the cost. Please be as specific as possible with which vendors you have talked with for each quote. Please also send any quotes you've received directly to Student Affairs Committee Chair Blair@queervirginia.org(Required)

Question 6: How will you encourage inclusivity and intersectionality (particularly if your event is not exclusively LGBTQ+ focused)?

This question is optional but recommended

Question 7: When would you ideally like a decision by, and when is the absolute latest you need funds by?(Required)

in addition will you also commit to submitting receipts of all related expenses to QVA, which will be used to confirm the amount provided in grants?

Yes

As a student group, you will often be able to receive significant discounts on location rental, food purchases, and other event expenses. Have you already asked your vendors for a discount as a non-profit student group?

Yes

Demographic Data Collection

QVA recognizes that even greater barriers stand in the way of people marginalized from within the LGBTQ+ community. The Board of Directors is committed to leveraging the programs, funds, and actions of QVA in ways that combat these barriers and work on behalf of equitable access to education and opportunities for student success. As part of our commitment, we seek demographic information from our scholarship applicants. This information is primarily used to help the Scholarship Committee evaluate QVA’s distribution of financial aid to marginalized people, including but not limited to people of color, gender diverse persons, and disabled persons.

Gender Identity (e.g. cisgender male, transgender female, non-binary, agender etc.)

Sexual Orientation (e.g. gay, lesbian, bisexual, etc.)

Romantic Orientation (e.g. homoromantic, aromantic, heteromantic, etc.)

Race/Ethnicity (check all that apply)

African American/African/Black

Indigenous People/First Nation/Native American/Alaskan Native

Native Hawaiian/Pacific Islander

Arab American/Middle Eastern/North African

Asian/Asian American

European American/White

Hispanic/Latinx/Chicano or Chicana

Unknown/Decline to State

Disability (check all that apply)

I am a person with one or more visible disabilities

I am a person with one or more invisible disabilities

I am a person without disabilities

Unknown/decline to state