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Club & Organization Fundraising Request Form
Student Activities Office Parsons Union Building Lock Haven University
2018-2019
Requests must be submitted at least 2 weeks prior to your fundraiser for full consideration.
*NOTE: Budget funds may NOT be used to supplement fundraiser expenses.
*ALL money raised must be deposited into the club’s special account*
Club/Organization Name: _______________________________________________________________
Contact Person: _________________________________Contact Phone #: ________________________
Proceeds will benefit: (If both a club & charity fundraiser, please check both categories)
provide charity information below
Charity Name: _________________________________________________________________
Contact Person at Charity: ________________________________________________________
Charity Address: __________________________________Phone #: ______________________
__________________________________Charity Tax ID #: ________________
Explanation of Anticipated Profit(s): $
____________________________________________ _________ ______
Club President Signature Date
_________________________________ ______ _________ ______
Club Treasurer Signature Date
_________________________________ ______ _________ ______
Club Advisor Signature Date
Day & Dates of Fundraiser:
Start: End:
On Campus Location: _________________________________________________
Off Campus Location: _________________________________________________
Detailed Description of Fundraiser: Failure to provide a detailed description will result in automatic denial.
