Oral Roberts University Alumni Foundation
Disbursement Request for Temporarily Restricted Funds
Name of Requester: ______________________________________________
Phone : __________________
Department: ______________________________
Alumni Foundation Account # of Fund drawn from- A______________
Amount of Request $________________
Purpose of Request :
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________
Specific Usage of Funds Requested:
___________________________________________________________________
What need is being met by the usage of these funds:
Authorized Signatures for request:
Requestor: ___________________________________ Date _________________
Dean of School or Chair_______________________________ Date _________________
Director of Alumni Relations ____________________ Date _________________