Request for support from Region 8 IEEE Voluntary Contribution Fund 	ver4
IEEE entity applying for support: (Section, Chapter or Student Branch)

Full identification of the entity:

Officer signing the application.on behalf of the entity:

Name:						Surname:

IEEE membership number:

e-mail:				fax:

Endorsement from an IEEE entity (Section or Chapter – not required for student members and committee members listed in Region 8 IEEE organizational roster):

Date and signature:						Office held:

Project name:

Project description: (Please, describe in brief how the project will improve the value of IEEE membership to members, how many members will benefit from the project and how, when and by whom will the project be carried out. If necessary, attach additional sheet of paper.)

Performance metrics: (Please, describe in brief the goals of the project. These goals will be used to evaluate project success at the end.

Request for support from Region 8 IEEE Voluntary Contribution Fund – page 2.
Aopplying IEEE Entity:  

Budget and bank information: Please, describe the cost of your participation, as well as the sources of money to meet it. Provide a complete information that could be used to send money to you

Total cost: (US$): 
(please, add a detailed description overleaf or on a separate sheet of paper.)

Amount requested from R8 VCF:

Bank, bank address:

Account number:

Owner of the account:

Have you received support from R8 VCF in the past? If yes, state the amount, year and purpose:

send the request to R8 VCF Coordinator at the address: Zbynek Skvor, dpt. of Electromagnetic Field, Technicka 2, 166 27 Praha 6, Czech Republic, 
e-mail: z.skvor@ieee.org, fax: +420-2-3119958
The request could be sent electronically in order to speed up the process, however the original bearing signatures should be sent as well.