Student Funding Committee
Date: ____________________________________________________________________________________________
Organization Name: ___________________________________________________________________________
Event or Conference Title: ____________________________________________________________________
Date of Event/Meeting Attended______________________________________________________________
Location of Event/Meeting: ___________________________________________________________________
Name of Person Submitting Request: ________________________________________________________
Phone Number: ________________________________________________________________________________
Please submit all ORGINAL receipts, invoices, contracts and/or performance
If reimbursement is for a conference, a copy of the front cover and conference agenda or if it
was an EVENT a flier is REQUIRED.
Pay to: _______________________________________________ Banner ID: _______________________________
(Full name of individual or organization) (If reimbursement is to student)
Address: ___________________________________________________________________
Phone Number: ______________________________________________
Total Amount Allocated by Student Funding Committee: _______________________
Total Amount Requested for Reimbursement: ___________________________________
No. of Receipts and Other Documents Attached: _________________________________
Check needed by (if needed by a certain time frame): ___________________________
Normal turnaround time for a check can be up to two weeks
NOTE: Please use the Excel Reimbursement Form, page 2, located on the SFC Webpage to itemize
expenses, explain expenditures, or add necessary details not clear on receipts.
Return both forms, along with receipts to Alice Dempsey, Student Recreation & Wellness Center,
Garrison 193 or Student Activities, Union 217. Please call 660-543-4245 with any questions about