Contingency Request
Student Activities Office Parsons Union Building Lock Haven University
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: $___________________________
_______________________________________________ ______________________________
Club President Signature Date
_______________________________________________ ______________________________
Club Treasurer Signature Date
___________________________________________________ ________________________________
Club Advisor Signature Date
Office Use Only
Approved ____Denied ____
Club Notified By: