Funding – Entertainers/Service Providers Intent To Entertain/Provide Services This is a standard form for anyone hoping to Intent To Entertain/Provide Services for a Tier II Funded Organization. Your Contact InformationName* First Last Address 1*Address 2Location*CityStateZipYour Email Address* Enter Email Confirm Email Do you work for the University or the State of CT in any capacity?*YesNoIf you answered "Yes" to the question above, please explain. What department do you work for? Are you full time? Part time? Special Payroll? Etc*Your Phone Number*Your Fax NumberWhich Student Group do you intend to work with?*Student Group Contact Email Address* Enter Email Confirm Email Event ScheduleEvent Dates*Start Date of Event (Month/Day/Year)End Date of Event (Month/Day/Year)Event Start Time* : HH MM AM PM Event End Time* : HH MM AM PM Duration of Service (# of minutes)*How long will you be performing?Performance Start Time* : HH MM AM PM Performance End Time* : HH MM AM PM Event Location*Where will the event be held?Service(s) Provided*Please describe, in detail, your participation in the event. Please include when you will arrive and depart and all that you will do in between.Additional InformationAre you a current UConn Student?* Yes No If you answered "yes" above, please check one of the boxes below:* Undergraduate Student Graduate Student Please Use The Space Below For Any Additional Information Not Provided Above.Fee and OtherWhat is The Agreed Upon Fee You Expect To Be Paid?*This is an all-inclusive honorarium.Your Resume/BioYou are required to upload your resume or bio. The file can be a Word document (.doc) or a PDF file (.pdf).File*Accepted file types: pdf, doc.Use this to upload your resume/bioSignature*Full NameDate By typing my full name and the date in the spaces above, I affirm that, to the best of my knowledge, the information which I have provided above is accurate and factual. I also understand that this is not a binding contract with the University of Connecticut, the Undergraduate Student Government at the University of Connecticut, nor any other group or team that I am corresponding with at the University of Connecticut.* I agree with the statement below. BY CLICKING THE CHECK BOX ABOVE, I AFFIRM THAT I AM NOT FILLING OUT THIS FORM FOR SOMEONE ELSE AND THAT I HAVE TYPED MY NAME IN THE SIGNATURE LINE ABOVE. IF I AM A STUDENT FILLING THIS OUT FOR ANOTHER PERSON I REALIZE THAT MY GROUP MAY LOSE ITS FUNDING FOR FALSIFYING THIS DOCUMENT.Please Type The Images Below So We Know That You Are Not A Computer!NameThis field is for validation purposes and should be left unchanged.