Changemaker Catalyst Award Confirmation Form - The Phyllis M. Taylor Center

The survey will take approximately 6 minutes to complete. To confirm your acceptance of the funding, complete this form. We will process your check which you can pick up at Taylor in approximately 2-3 weeks after confirming your adherence to the items outlined below.

1.1 Name*

First Last

1.2 Tulane email address*

Enter Email Confirm Email

1.3 Phone Number*

1.4 Student ID Number*

1.5 Expected Graduation Year*

1.6 Expected Graduation Semester*

1.7 Total Amount Approved (The amount can be found on your award letter.)*

1.8 Provide one sentence on how you will use the funding. Changemaker Catalyst Award to support [X]*

1.9 Upload Your Award letter (pdf)* This is the letter you received via email.*

Drop files here or

Accepted file types: pdf, doc, Max. file size: 50 MB, Max. files: 2.

1.10 Please read each statement, sign the student agreement and upload the document to complete your application.*

View Agreement Here

Drop files here or

Accepted file types: pdf, doc, mp3, mp4, xls, csv, Max. file size: 50 MB, Max. files: 2.

1.11 How would you like to receive the funding?*

Direct Deposit
Check by Mail

1.12 Upload documents for payment. In order to receive award funding, applicants must upload the required documents for payment:*

– To receive the award, domestic applicants must have a W-9 form completed as an individual or legal entity W-9 Form
– For International Students: In order to process the payment for international/undocumented/DACAmented students, you must submit — a completed W-8BEN Form
AND — your GLACIER Tax Summary Report which can be requested from the Tulane International Tax Office by contacting ito@tulane.edu
-If you selected to be paid by direct deposit, complete and submit a direct deposit form

Drop files here or

Accepted file types: pdf, doc, Max. file size: 50 MB.

1.13 Have you ever worked as a student employee at Tulane or been on Tulane's payroll system?*

Yes
No

Name

This field is for validation purposes and should be left unchanged.