CEO Request Form

What best describes the nature of this request? *

Introductory Meeting Follow-up Meeting Site Visit Event Attendance

Are you submitting this on behalf of someone?

YesNo

Enter your contact information:

First Name

Last Name

Email Address

Who is this request on behalf of?

Enter your contact information:

First Name

Last Name

Title

Organization

Email Address

Phone Number

What is the purpose of the meeting? *

What are you hoping to discuss? (e.g. agenda, list of topics/questions) *

Please select your desired meeting location. *

In-person Online/Virtual Phone

What is the date of the event? (YYYY-MM-DD)

What time is the event?
Please include the time zone (AST, EST, CST, MST, PST, AKST, HST, UTC-11, or UTC+10

Where will the event be located?

Please provide a description of the event, or a link to the website if available.

Has your organization received funding from the Kauffman Foundation in the past? If yes, please describe.

Do you plan to make a funding request?*

Yes No

Please list the name(s) of any Kauffman associates you have worked with previously (e.g. Program Officer).

I agree that the Foundation may use my personal information to communicate with me about the Foundation and programs I may find interesting, to personalize my experience on Foundation web sites, conduct academic/charitable research, collect data about me from other sources, and share my data with trusted Foundation affiliates. Please review our privacy policy which provides info on how we use, process, and protect your data.*