Office of the Controller Only:
Reviewed: _________________ Endorsed: _______________
Rev 101810
University of West Georgia
Food Purchase with Institutional Funds
Date: __________________ _________________ Date of Event:
Meeting Type:
Prgm Name: _________________________________________________________
Educational/Business
(Mostly non-Employees)
Purpose of the meeting/event:
Topics Discussed:
(documentation that substantiates the event was an official event, i.e., flyer, agenda, email, or other substantiating
documentation).
List of attendees & affiliation
(for groups more than 10, indicate the approximate number of attendees and identify
the group)
Approx Number in attendance if more than 10:_______________________________________
Identification of the Group: __________________________________________________
Certification of containment of cost within per diem amounts.
I certify the amount expended did not exceed the authorized per diem amount uniquely indentified
for the particular meal and no institutional funds were used to purchase alcoholic beverages.
I understand and ensure that the funds spent were only for legitimate public purposes and not for
the personal benefit of the employee or other individuals.
I understand the misuse of institutional funds may result in disciplinary actions up to and including
termination; as well as, civil action and criminal penalties.
Requested by:
_______________________ ____________________________________
Print Name Signature
Department Manager (should not be requestor):
_______________________ ____________________________________
click to sign
signature
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