Fillable FUNDRAISING REQUEST FORM Please submit this form to (Southern University at Shreveport)

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FUNDRAISING REQUEST FORM Please submit this form to (Southern University at Shreveport)

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1 | P a g e
“FUNDRAISING REQUEST FORM”
Please submit this form to the Chancellor of SUSLA or the Chancellor’s Designee (Office of Institutional
Advancement) at least 30 days prior to the fundraising activity date:
Name of Club/Organization: ______________________________________________________
Date: ________________________________________________________________________
Faculty/Staff Advisor: __________________________________________________________
Chairperson of Club/Organization: ________________________________________________
Name of Fundraising Activity:
______________________________________________________________________________
Date of Fundraising Activity: _____________________________________________________
Location: _____________________________________________________________________
Time: ________________________________________________________________________
Purpose of Fundraising Activity: __________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Description of product/service to be marketed: ____________________________________
____________________________________________________________________________
Target Market: _______________________________________________________________
Method of Marketing/Sales: _____________________________________________________
____________________________________________________________________________
REQUIRED (IF APPLICABLE):
Off-Campus Group/Organization Participation: ______________________________________
Signature: ________________________________________________________________
Club/Organization Advisor
________________________________________________________________
Dean/Director of Student Services (if applicable)
________________________________________________________________
Chancellor/Chancellor’s Designee (Institutional Advancement)
* Attach a copy of the minutes from the meeting in which the activities and expenditures were approved.
Approved Denied
Chancellor’s Signature or Designee: ___________________________________________________
cc: Facilities, and events coordinator. Additional copies will be made for appropriate offices.
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2 | P a g e
OUTCOME OF THE FUNDRAISING ACTIVITY REPORT
This report must be submitted to the Chancellor or Chancellor’s Designee (Office of Institutional
Advancement) within two (2) weeks of completion of the activity.
Name of Club/Organization:
________________________________________________________________________
Name of Fundraising Activity: ____________________________________________
_______________________________________________________________________
Date of Report: _________________________________________________________
Faculty/Staff Advisor: ___________________________________________________
Chairperson of the Club/Organization:
_______________________________________________________________________
Outcome of the Fundraiser: ______________________________________________
_______________________________________________________________________
_______________________________________________________________________
Funds Spent: ___________________________________________________________
Funds Received: ________________________________________________________
Overall Evaluation of the Activity: __________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Signature: ______________________________________________________________
Club/Organization Advisor
_________________________________________________________________
Dean/Director of Student Activities
_________________________________________________________________
Club Chancellor
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FUNDRAISING REQUEST FORM Please submit this form to (Southern University at Shreveport)

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Completed 17 September 2020

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