Request funds for your GSA.

If you belong to or advise a GSA (Gay, Straight Alliance) in a Utah middle or high school, and you would like to request funds, please complete the form below.

Please note that we have a limited amount of funds available for GSAs. We will do our very best to accommodate your request, but we cannot guarantee fulfillment. We will process all requests as quickly as possible, but please allow up to two weeks for delivery.

School Name *

GSA Advisor full name *

Advisor's Email *

Contact Email (if not advisor)

Number of students in your GSA (appx)

Paste URLS and descriptions of requested items here: (i.e. food, decorations, admission costs, bus rentals, etc.) *

Address where items should be shipped

Address Line 1

Address Line 2

City

State

Zip Code

Please describe your event / purpose for your request (How will your request be used? What impact do you foresee the request (event or other) having on your students? *

If GLSEN is able to fulfill the request to my GSA, I agree to report back afterwards to let them know what impact it had on my students. *

I agree