Please list all that apply:
TOTAL AMOUNT REQUESTED $_______________
Please attach information regarding conference/event agenda, registration fees,
hotel, per diem, car rental, and any other additional information for the committees’
consideration.
Approved □ Amount$________________ Denied □
______________________________________ ________________________
Dr. Deborrah Hebert, Dean of Student Services Date
Organization Revenue/Contributions:
Fundraisers $__________
Membership Dues $__________
Donations $__________
Other $__________
Total Contributions $__________
$____________ x ______ people $______
Transportation:
Airfare
$____________ x ______ people $______
School Van (fuel) $______
Rental $______
Fuel $______
Parking $______
Hotel:
$_____ x ___ rooms x _____ nights $_______
Food:
$____ /day x ____ days x ___ ppl $_______
Other (list items):
____________________________ $_______
____________________________ $_______
