Club Name: _________________________________________ Date: ______________
Club Contact: ________________________________________ Phone: _____________
Campus Address: ___________________________________ E-mail: ________________
Amount of Request: ___________________________ Date Required: _______________
This
request is for a: Tangible Item Intangible Item
Detailed Description of Request:
_______________________________________________
___________________________________________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________
_________________________________________________________________________
***You must attach at least one price quote for the item/event that you
are requesting money for to this form***
***You must attach a summary budget form for your club to this form***
Does your club currently receive money from the
University? Yes No
If
yes, how much annual? ________________
Matching
funds? ________________
Incentive Money? ________________
Fundraising completed/planned for this semester:
_________________________________
_________________________________________________________________________
_________________________________________________________________________
Club Contact Signature:
____________________________________ Date:
____________
Campus Recreation Director:
________________________________ Date:
____________
Sport Club Coordinator: ____________________________________ Date: ____________