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UCLA Procedure 113.0 :
Attachment A
Proposal Form for Memorial and Honorific Objects
UCLA Policy 113, Memorial and Honorific Objects, describes under what circumstances a proposal for a Memorial or Honorific Object in honor or memory of an individual, group, or event may be considered for approval. It is recommended that this Policy be read before submitting a proposal. This form may be used or equivalent document that contains the required information for preparing a proposal. If a gift is involved, please contact External Affairs.
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Date: __________________________ |
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Proposer (Name):_______________________________
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Department: ___________________________________
(if applicable) |
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Representing:____________________________________________________________________________________
(if applicable) |
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Email: _____________________________________
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Phone: ________________________________
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Type of Memorial Object (please check):
__ Bench __ Fountain __ Monument __ Plaque __ Sculpture __ Other (please specify)
_______________________________________________________________________________________________
Subject of Memorial Object:__________________________________________________________________
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Description of Subject (attach additional pages as needed):___________________________________________
Proposed verbiage on Memorial Object:____________________________________________________________ _______________________________________________________________________________________________
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Suggested location of Memorial Object and reason.
________________________________________________________________________________________________
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Source of funding for Memorial Object design and manufacture, installation and maintenance costs:
________________________________________________________________________________________________
________________________________________________________________________________________________
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Is a dedication ceremony planned? If yes, describe including desired date and source of funding:
________________________________________________________________________________________________
________________________________________________________________________________________________
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Submit the completed form and any additional pages to:
Office of the Vice Chancellor & Chief Financial Officer
405 Hilgard Avenue
Murphy Hall 2147
Los Angeles, CA 90095
Attn: Memorial and Honorific Objects
405 Hilgard Avenue
Murphy Hall 2147
Los Angeles, CA 90095
Attn: Memorial and Honorific Objects