ASSOCIATED STUDENTS of CAÑADA COLLEGE
4200 Farm Hill Blvd., Redwood City, CA 94061
650-306-3364
This form can be used to request a check OR get reimbursed.
For reimbursement, ORIGINAL receipt(s) needed.
Who is the Check Being Written to?
(If this is a department transfer, please include full department account number.)
________________________________________________________
Name of Person Filling out Form: ____________________________
Today’s Date: ____________________________________________
Club or Department Check is Related to: _______________________
Would You Like Your Check Mailed to the Recipient?
If yes, please write in the full address. If no, please write “N/A”
_____________________________________________________________
_____________________________________________________________
Would you like to physically pick up your check in Building 9?
If yes, please provide a phone number to call you at when the check is ready.
______________________________________________________________
QUANTITY
ITEMS Description
UNIT PRICE
TOTAL PRICE
TOTAL
I hereby certify that to the best of my personal knowledge the articles requested hereon are necessary for use by ASCC organizations.
Club Treasurer ______________________ DATE: Student Life & Leadership Manager ___________________ DATE:
Club Advisor ______________________ DATE: ________ ASCC Treasurer ____________________________________ DATE:
Vice President of Student Services ______________________ DATE: ________
Please review all policies and procedures regarding Funding Requests and Requisitions at
http://www.canadacollege.edu/studentlife/fundingrequest.php
Please allow up to three weeks for your check to be processed.
White-Cashier’s Office Yellow-Student Life
Pink-Your Copy
REQUISITION
For Office Use Only:
Club/ASCC Account Charged To:
________________________________________
Club/ASCC Meeting Date Money Was Approved:
________________________________________
How Much Was Approved on Meeting Date?:
________________________________________
Business Office Check #:
________________________________________
Club
ASCC
Vending Commission
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