Student Club & Organization Funding Request
Club Name:
37… Account Number:
2018- 2019 Anticipated Costs (should not exceed $500.00)
*For each activity you have planned that will require funding, please complete a separate Activity
Description section.*
1. Activity Description:
Does this activity include travel?
Are any associated costs listed below for fundraising purposes (e.g. to purchase food for sale)?
Associated Costs (Add lines as needed):
1) Cost:
2) Cost:
3) Cost:
Total Cost: Club Contribution:
Amount Requested:
-------------------------------------------------------------------------------------------------------------------------------
2. Activity Description:
Does this activity include travel?
Are any associated costs listed below for fundraising purposes (e.g. to purchase food for sale)?
Associated Costs (Add lines as needed):
1) Cost:
2) Cost:
3) Cost:
Total Cost: Club Contribution:
Amount Requested:
-------------------------------------------------------------------------------------------------------------------------------
Campus Wide Activity Description to be hosted during the 2018-19 academic year:
By signing below, I attest that the anticipated costs outlined above were agreed by the club and approved by a
designated faculty or staff advisor. The club has attached quotes or other examples of cost estimates for each
of the associated costs listed. Additionally, the club understands that any amount requested from the Student
Senate Account for the purposes of generating club revenue must be returned to the Business Office following
the completion of the fundraising activity. I understand that my club/organization is responsible for hosting
one student activity on campus as described above. In addition, I agree that a representative from my
club/organization will attend the Student Senate meetings. Failure to complete the student activity or missing
2 or more Student Senate meetings will result in a loss of funding for the 2018-2019 academic year.
Required Signatures
(Requests will not be considered without all signatures)
_______________________________________ _____________
Club President Date
_______________________________________ _____________
Club Treasurer Date
_______________________________________ _____________
Club Advisor Date
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