Student Clubs and Organizations Request for Disbursement of Funds

Student Clubs and Organizations Request for Disbursement of Funds

Please complete Sections One-Four of this form. Present this form to the Student Senate advisor in Wynn1209, at least two months prior to the need for funding. The Senate advisor will share this form with the Senate Treasurer.

Section One:Funding Information for 20__-20__

Total funds allocated: Click here to enter text.Total funds disbursed to date: Click here to enter text.

Total funds requested for activities summarized below: Click here to enter text.

Section Two: Disbursement Summary

Please give a detailed disbursement summary of the activities, supplies, and other expenses covered by this disbursement. (Reminder: receipts for all expenses must be turned into the Business Office and copies to Senate advisor in Wynn 10-209 within 30 days of expenditure.)

Activities, supplies, etc.Amount

______

______

______

______

______

______

______

______

Name of vendor to make payment to: Click here to enter text.______

Mailing address of vendor: Click here to enter text.______

Click here to enter text.______

Total amount of payment to vendor: Click here to enter text.______

Things to remember:

1. Is this is a new vendor? If it is, please be sure to have them complete a W-9 form and the Durham Tech Vendor application.
2. Do you need to use the Durham Tech credit card for this purchase? If you do, please contact the Student Activities Coordinator at 919-536-7200, extension 1410 to make arrangements to use the credit card.
3. Is this a reimbursement for items already purchased? If it is, have you made copies of the receipts for your records and copies to be submitted to the Student Senate advisor?

Section Three: Disbursement

Student activity funds will not be available until the date the funds are required for the activity. Please list the date these funds are required and the justification for this deadline.

Date required: Click here to enter text._Justification:Click here to enter text.______

Make check payable to: Click here to enter text.______

Note: Please be sure to provide the Student Senate advisor with any vendor price quote(s) when submitting this form. If the funds are for reimbursement, be sure to submit receipts with this form. Checks will not be made out directly to club or organization advisors, unless it is a reimbursement.

Section Four: Signatures

______
Senator/DatePhone Number

______
Club Advisor/DatePhone Number

Section Five: Senate Advisor Information

Senate Advisor/Date Received: Click here to enter text.Date Requisitioned: Click here to enter text.

Unused funds are to be returned to the Business Office within 30 days of the event with a copy of the receipt attached. A copy must also be sent to the Student Senate advisor in Wynn 10-209.

Amount returned: Click here to enter text.

Date received: Click here to enter text.

Senate treasurer signature: Click here to enter text.

Senate advisor signature: Click here to enter text.