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Club Senate Funds Request Form

Club/Organization ______

Club Advisor ______Phone number ______

Club Senator______Phone number______

Club President ______Phone number______

Date of Event Start: ______Date of Event End: ______

TOTAL AMOUNT REQUESTING:

$______

Directions:

Please complete pages 1 through 4 fully. If your club is traveling, you are also required to complete pages 5-8.

In addition to this packet, you must also include the following!!

Before the Funds Council will consider processing your request, a written description MUST accompany this form.

A written description of the event and how it will benefit your members.

* If the request is for a guest speaker or advertising, explain the purpose and whom to pay.

*If the request is for travel, a Travel Authorization (“T.A.”) is required prior to your trip in

order to receive funding. Please contact SURC Accounting for instructions on how to

complete this step. ( , or 509-963-1328 )

As the President/Advisor for the club/organization named above, I hereby state that the facts found on/with this request are presented fairly and truthfully to the best of my knowledge. I have read and understood the attached sheet entitled “Club Senate Funds Request Procedures” and have verified the completeness of this Funds Request Form.

______

Club President’s Signature Club Advisor’s Signature Date


Alcohol Guidelines and Agreement

As a recognized club or organization of the ASCWU, you are representing Central Washington University at all times. Keep this in mind while attending, promoting and planning all events.

·  Your club or organization should be aware of the potential risks of the use of alcohol during trips and / or meetings. The club/organization and its members are responsible for their actions while on trips and activities and are expected to act in a responsible manner that is consistent with the laws of the United States, Washington State and Central Washington University.

·  The use of State vehicles to transport alcohol, or to transport persons to and from establishments with the primary purpose of selling alcohol, is prohibited.

·  It is expected that all recognized Central Washington University clubs/organizations will behave in a responsible manor in regards to drinking and driving, and will work to assure a safe ride home for those intoxicated.

·  The Senate for Student Organizations wants to promote the idea of “Responsible Freedom” and allow clubs/organizations to participate in any activity in which they choose. However, we ask you to remember that you are representing Central Washington University in all activities in which you participate.

I hereby agree to follow the above guidelines

______

Club President (Please Print) Club President’s Signature


ITEMIZED BUDGET:

Please Include ALL COSTS and ALL FUNDRAISED DOLLARS Related to your event EXCEPT food costs.

Cost Category / Description/Type/Location / Cost
Registration Costs
Guest Speaker Honorarium
Airfare / +
Hotel / +
Advertising / +
Room/Equipment Rental / +
CWU Motor Pool / +
Other Transportation / +
+
+
SUBTOTAL:
Club Account Dollars
Other Fundraised Money / -
Other Fundraised Money / -
TOTAL AMOUNT NEEDED:

LIST OF EVENT PARTICIPANTS:

Participant Name: / STUDENT ID # (Indicate if not a Student) / Phone Number: / CWU E-Mail
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.

* If more participants than 16, please list on an additional sheet the names, ID #’s and phone #’s for each.

SURC Accounting Official: ______Date: ______


QUESTIONS FOR FUNDS COUNCIL

1.  What is the total cost of the intended event? (Note: This does not include funds required for food or any other item not funded by Senate money. This is the total cost of the event, not the total amount of money you are requesting from senate. This number should be the same as your “Cost Sub-Total” on the Itemized Budget Section of the Form.)

$______

2.  How much money is the club spending out of its club account? This does not include funds required for food.

$______

3.  How much money is projected that each participating member will pay out of pocket if Senate Funding is allocated? This does not include funds required for food.

$______

4.  What different fundraisers has your club done for this event?

______

5.  How much monetary support has your club received for this event from other entities?

$______


TRAVEL ITINERARY

Clubs utilizing Club Senate funding for an event that requires travel must complete the below form as part of the funding request process. This form must be completed and submitted with the funds request packet and any updates must be made prior to departure on trip/activity. If your event does not require travel, please disregard the remaining pages.

The itinerary information is for the purpose of establishing emergency contact with the group and participants. This form must be completed for all domestic travel in the United States. For travel internationally, or to rural areas please contact the Senate Treasurer for more information on additional university approval that may be required.

Club Name: ______

Designated Traveling Group Leader: ______

Cell Phone: Email Address:

Date of Departure: Date of Return:

Location Traveling to:

Please list your advisors name and cell phone if he/she is attending as well:

Advisor: ______

Cell Phone: Email Address:

TRANSPORTATION ITINERARY INFORMATION:

Air Travel:

Airline:

Departing Flight Number(s): Returning Flight Number(s):

______

______

______

______

______

______

______

______

ACCOMMODATIONS INFORMATION:

Lodging Accommodations:

Name of Lodging:

Location of Lodging:

Phone Number of Lodging:

Duration of Lodging: ______

***If lodging at multiple locations during the trip please attach a supplemental list of the above information for each location of lodging.

If staying in an outdoor location, please list the exact physical location by being as specific as possible: ______

______

______

DAILY ITINERARY INFORMATION:

Description of Day Itinerary:

Please summarize below your anticipated itinerary for each day of your trip:

Day# 1

Day #2

Day #3

* If more than 3 days or need of more space, please attach an additional sheet with required information

AUTHORIZATION SIGNATURES:

I hereby affirm that the above information listed is true and correct to the best of my knowledge. I understand that there is no liability insurance currently provided by CWU for the club or its participants in personal motor vehicles. I further acknowledge that all participants have signed both an Insurance Waiver and Health Waiver and that our group leader has picked up a copy, read and understood the “Club Insurance Handbook”. We acknowledge that there may be inherent risks associated with our trip and agree to not hold Central Washington University, any of its entities or the ASCWU-BOD responsible for any losses of life or property that may be incurred as a result from our trip.

Travel Leader: ______Signature______T.A.#______

I have reviewed the above travel authorization and believe it to be in compliance with Club Senate and University policy.

NOTE: ANY CHANGES OR UPDATES MADE TO THE TRAVEL ITENARY SECTION OF THIS FORM ARE TO BE MADE BY CONTACTING THE CLUB SENATE TREASURER.

Description of Event

A written description of the event and how it will benefit your members.

* If the request is for a guest speaker or advertising, explain the purpose and whom to pay.

______

Revised 10-7-15