Agency Fund Information Sheet
Financial Services Department
Accounting Office – Box 437
Criteria for establishing agency funds, descriptions of general agency fund categories, as well as agency fund terms
and conditions are specified in the Gettysburg College Agency Fund Guidelines.
Requestor Name: ________________________________________________________________________
Requested Name of Agency Fund: ___________________________________________________________
Requesting Organization Name: __________________________ Assigned Gettysburg College Budget :Y N
If yes, generally not eligible for agency fund.
Agency Category (check one): Student Organizations and activities
Faculty and staff organizations and activities
Other agency activities
Purpose of Agency Fund: __________________________________________________________________
If Gettysburg College budget, specify rationale for agency activities (personal benefit of members).
Describe revenue sources: Describe expense activities:
As the responsible individual for the requested agency fund, I affirm that the above activities are in accordance with
the Gettysburg College Agency Guidelines and acknowledge and accept the terms and conditions relating to agency
funds specified therein.
Responsible Individual (RI) __________________________________________
Signature
__________________________________________
Name (If different than requestor)
RI Contact Information:
______________________ ___________ _____________ _________________
Student Graduating Year/ Campus Box Phone extension Email address
Employing Department
Agency Relationship Recommended by: ___________________________________________
Signature
___________________________________________
Name
For Accounting Office Purposes:
Authorized by:___________________________________________
Agency Fund Assigned:________________________________________ Agency Fund Created by: __________________________________
