The Crafton Hills College Foundation requires that ALL requests for disbursement of funds be documented
on this form, signed and submitted by the approved Account Manager and accompanied by an invoice or
original receipts not to exceed the approved amount. This applies to payment for goods or services, or
reimbursements to vendors, faculty, or staff of Crafton Hills College for approved functions.
The CHC Foundation is a non-profit tax-exempt corporation organized under the laws of the state of
California and Section 501(c)(3) of the Internal Revenue Code of 1986, as amended. By signing this form, the
requestor agrees to utilize all funds in such a way as to never endanger the Foundation’s exempt status as
determined by the Internal Revenue Service code governing 501(c)(3) public charities.
Michelle Riggs, Director of Community Relations and Resource Development
11711 Sand Canyon Road - CTB 209, Yucaipa, California 92399-1799
FOR OFFICE USE ONLY:
FUND BALANCE: $
ACCOUNTING CODE:
DEPARTMENT:
EVENT OR ACTIVITY:
REASON FOR REQUEST:
MAKE CHECK PAYABLE TO:
MAIL TO:
ACCOUNT NUMBER :
DATE OF EXPENSE:
AMOUNT REQUESTED: $
NAME OF REQUESTOR:
SIGNATURE OF REQUESTOR:
APPROVED BY:
DATE:
DATE:
FOOD: $_____________
EQUIPMENT: $_____________
CONFERENCE: $_______________
PROMOTION/MARKETING: $_______________
SUPPLIES: $______________
TRAVEL: $______________
OTHER: $ /
REQUEST FOR FOUNDATION FUNDS
RETURN TO:
SIGNATURE:
DATE:
For additional information or questions,
Please Contact:
Michelle Riggs
mriggs@craftonhills.edu or 909.389.3391
TYPE OF EXPENSE:
(DESCRIBE TYPE OF EXPENSE)
CALL:
E-MAIL:
OR NOTIFY ME WHEN THE CHECK IS READY, AND I WILL PICK UP THE CHECK FROM THE FOUNDATION OFFICE:
AS OF:
APPROVED AMOUNT: $
