Check Request Form
PRINT NAME & SIGNATURE OF PERSON REQUESTING FUNDS
APPROVAL DIVISION DEAN/DEPARTMENT CHAIR
Authorizing Fund Signatory
APPROVAL CINDY GOGA
Authorizing Fund Signatory
DVCF will automatically mail the check to the Check Payee Address above. If you want this check returned to you
or someone else write the name & mailing address in this box:
SCAN AND EMAIL COMPLETED FORM WITH SUPPORTING DOCUMENTATION TO FOUNDATIONCHECKS@4CD.EDU
COMPLETED CHECK REQUESTS RECEIVED BEFORE 5pm on FRIDAYS will be printed and mailed the following week.
DATE OF REQUEST
AMOUNT
CHECK PAYEE
CHECK PAYEE ADDRESS
FUND NAME
MEMO INFORMATION Enter p
urpose of
check and attach supporting documentation. i.e.
Board minutes, student enrollment, receipts,
invoices or etc. If check is for a student include ID
and current schedule.
CONTROL ACCOUNT No.
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