Is this a stipend? Yes No
If Yes, is the payee a college employee (includes hourly, college assistants, regular employees)?
Yes No
If Yes/Yes, Foundation check must be made payable to PCC and stipend
paperwork and payment processed through Human resources/ Fiscal Services.
If Yes/No, please attach completed W-9 (unless W-9 previously submitted).
(Note: No Foundation stipend check will be issued without
W-9 form for payee on file with the Foundation office.
PASADENA CITY COLLEGE FOUNDATION
REQUEST FOR DISBURSEMENT
Requested by: Date:
Issue a warrant from the
(Foundation Fund Name)
Expense account No.: In the amount of $
Made payable to:
Hold payment for pick-up
Call at Ext. when check is ready.
Send Payment to:
Name:
Address:
City: State: Zip:
This disbursement covers the cost (or) services of:
ORIGINAL substantiating documentation (receipts, invoices, purchase orders, etc.) MUST be
attached. Expenses must be in accordance with any donor or grant restrictions.
Authorized approval – Two (2) signatures are required:
Print Name Signature Ext.
Print Name Signature Ext.
Rev 01/08
