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Contingency Request
Student Activities Office Parsons Union Building Lock Haven University
2018-2019
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ALL requests must be submitted at least 2 weeks prior to your activity for full consideration.
Club/Organization Name: __________________________________________________________________________
Contact Person: __________________________________________________________________________________
Cell Phone Number: _______________________________________LHU Email: ______________________________
What type of Contingency are you requesting?
General – For an event or program already in the current budget in which there are insufficient funds.
New Activity- To plan a new club activity not currently funded or for a newly approved club to request funding.
Uniform Funding – To request funding for new uniforms. Must meet establish uniform replacement guidelines.
Provide a detailed description of your activity, including a cost breakdown budget.
Failure to provide a detailed description will result in automatic denial.
Use additional paper or back of sheet if necessary.
Total Amount Requesting: $___________________________
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Club President Signature Date
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Club Treasurer Signature Date
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Club Advisor Signature Date