\documentclass[11pt]{article}
\usepackage[margin=1in]{geometry}
\usepackage{setspace}
\usepackage{helvet}
\renewcommand{\familydefault}{\sfdefault}

\setlength{\parindent}{0pt}
\setstretch{1.2}

\begin{document}

\begin{center}
    {\LARGE \textbf{Workshop Funding Request - Institute for Fundamental Theory}}\\[1em]
    {\large University of Florida}
\end{center}

\vspace{1.5em}

\textbf{Title of Workshop:}\\[0.5em]
\vspace{1cm}

\textbf{Proposed Dates:}\\[0.5em]
\vspace{1cm}

\textbf{Proposed Format (talks, discussions, etc.):}\\[0.5em]
\vspace{1cm}

\textbf{Expected Number of Participants:}\\[0.5em]
\vspace{1cm}

\textbf{Funds requested from IFT:}\\[0.5em]
\vspace{1cm}

\textbf{
Other sources of funding sought or anticipated, and amounts pledged or requested:}\\[0.5em]
\vspace{1cm}

\textbf{Additional Notes:}\\[0.5em]
\vspace{1cm}

\vfill
\textbf{Submitted by:} \hspace{0.5cm} \underline{\hspace{0.5\linewidth}}\\[0.3cm]
\textbf{Date:} \hspace{1.3cm} \underline{\hspace{0.3\linewidth}}

\end{document}

%%% Local Variables:
%%% mode: latex
%%% TeX-master: t
%%% End:
