Student Activities Request
Sponsoring Club/Group: _______________________________________________________________________________________
Student Representative Name: __________________________ Student Representative Signature: ___________________________
Sponsor Name: _______________________________________ Sponsor Signature: ________________________________________
Choose ONE of the following descriptions for your request: Activity, Travel, Purchase
Activity Request (Attach itemized budget and additional documentation as directed)
Activity: ___________________________________________ Date(s): ______________________________________________
Time(s): ___________________________________________ Location(s): ___________________________________________
Description of Activity and Purpose:
Total Cost: _____________ Funding provided by Club/Group: _____________ Funding requested of SGA: _____________
Travel Request (Attach Travel Addendum and additional documentation as directed)
Travel/Conference: _________________________________ Location: _____________________________________________
Departure Date/Time: _______________________________ Return Date/Time: _____________________________________
Description of Travel and Purpose:
Total Cost: _____________ Funding provided by Club/Group: _____________ Funding requested of SGA: _____________
Purchase Request (Attach itemized budget and additional documentation as directed)
Description of Items and Purpose:
Total Cost: _____________ Funding provided by Club/Group: _____________ Funding requested of SGA: _____________
Note: If clubs/groups are requesting funds from SGA when they already have funds in an agency account, a budget breakdown
must be attached explaining the intended allocation of those funds.
______________________________________________________ ____________
Student Government Association President Date
______________________________________________________ ____________
Student Life Coordinator Date
______________________________________________________ ____________
Associate Provost Date
______________________________________________________ ____________
Provost Date
______________________________________________________ ____________
Vice President, Operations Date
______________________________________________________ ____________
Vice President, Academic Affairs/Chief Learning Officer Date
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