Fillable SSF Department Funds Request 2019 2020 (Lamar State College)

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SSF Department Funds Request 2019 2020 (Lamar State College)

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Lamar State College-Port Arthur
Department Annual Funding Budget Request 2019-2020
Department Name: ______________________________________________________________
Contact Person: __________________________ Title/Position: __________________________
Email: __________________________________________ Phone: _______________________
Program Name: _______________________________ Head Count By Major: ______________
Faculty Count (full & part time): __________________ Enrollment Count: _________________
Recruiting efforts of program: _____________________________________________________
Describe how program goals are being achieved: ______________________________________
_____________________________________________________________________________
Is the program “effective” based on your analysis? (Please describe) ______________________
_________________________________________________________________
Reason for Request (include all dates, locations, number of students attending, etc):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
How does this event meet the college’s goals and mission? __
______________________________________________________________________________
Has your department received an annual budget allocation? Yes No
If so, Date__________________ Amount_________________
Have those attending paid their membership dues? ________
____________________________
_____________________________
APPLICANT INFORMATION
PROGRAM INFORMATION
PROPOSAL INFORMATION
We, the undersigned, certify that we are current department representatives of the
above campus departments and that the event specified will be held in accordance
with all municipal, state, and college regulations regarding such events. Further,
we assume collective and individual responsibility for the orderly conduct of this
event in accordance with the LSCPA Student Handbook.
________________________________ _________________________
Department Representative Date:
________________________________ _________________________
Department Chairperson/Director Date:
________________________________ _________________________
Received By (Committee) Date:
SIGNATURE OF DEPARTMENT
Please list all that apply:
Salary Requests: Travel Requests:
(Hourly rate x Total hours = total wages) Conference Fee:
Staff/Faculty Wages $ $_________ _____x_____people $_____
Student Assistants $_________ Airfare
$_____x_____people $_____
General Requests: Hotel
Contracts $_________ $___x___rooms x___nights $_____
Guest Speakers $_________ Food (per diem)
Royalty Payments $_________ $_____
Advertisement $_________ $_____
Printed Materials $_________ $_____
Scholarships $_________
$___ /day x __ days x __ people
Fuel
Parking
Other Items__________________
Refreshments $_________ __________________ $_____
Gifts $_________
Equipment Rental $_________
Equipment Purchase $_________ TOTAL REQUESTED AMOUNT $_____
Costumes $_________
If additional request items are needed,
please attach an itemized budget with costs.
Department Funds $__________
Other College Funds $__________
Ticket Sales/Revenue $__________
Approved □ Amount$________________ Denied □
______________________________________ ________________________
Dr. Deborrah Hebert, Dean of Student Services Date
BUDGET PROPOSAL
DEPARTMENT REVENUE/CONTRIBUTIONS
COMMITTEE APPROVAL
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SSF Department Funds Request 2019 2020 (Lamar State College)

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Completed 15 July 2020

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