Broadcasther Grant Agreement - 1000 Dreams Fund

Term

Name(Required)

First Middle Last

Birth Date

Twitch username if applicable

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What is your gender?(Required)

Please select all that apply, this information will not be shared publicly.

Sexual Orientation(Required)

Please select all that apply, this information will not be shared publicly.

Phone(Required)

What is your ethnicity? (Please select all that apply)(Required)

Email(Required)

College/University

N/A if not applicable

Field of Study

N/A if not applicable

Anticipated Graduation Date

Leave blank if not applicable

Payment Method(Required)

Please keep in mind that PayPal is our only method to pay international recipients - if you might need accommodations or have questions please feel free to email BroadcastHER@1000DreamsFund.org

Please share your PayPal email to send your reward payment if this is your preferred method.(Required)

Please share the address your check should be sent to if different from above.(Required)

Also please share any details about a different addressee name that we should know.

Please confirm the amount of your grant per the offer from 1,000 Dreams Fund.(Required)

This is included in the email you received from 1DF!

How will this grant be used?

I hereby understand and accept the terms of this grant award, as specified in my award letter that was provided to me. Further, I understand the following:

(a) My award is only for the current academic year, unless otherwise stated in my award letter;
(b) I will use my funds for the intended purposes in outlined in my answer to the question: "How will this grant be used?"
(c) If I do not meet the requirements explained to me in my award letter, I forfeit any unpaid payments.

Agreement(Required)

I understand

BroadcastHer Agreement

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