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THIS FORM MUST BE FILLED OUT, PRINTED, AND SIGNED BY THE
CLUB/ORGANIZATION PRESIDENT OR TREASURER ONLY

Contact Information

 

  Fund:    If SGA, fundraising money?:

   U.S. citizen?:

 

Is payee a PSU employee?:

Officer Information

Position/Office held (check one):

Is original backup documentation attached (receipt, quote, and/or contract)?

Note: Check processing requires a minimum of 3 weeks from the date received by Student Affairs. If all information on this form including backup documentation is not provided, your request will not be processed.


FOR OFFICE USE ONLY

Check one:

 

Balance of fund prior to check: