Liberty University Club Donation Request Form. Club Information! Date. written to him or her by Liberty University?!! Yes No. Treasurer ID #!

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1 Club Information This form must be filled out by the Club Treasurer. All sections must be filled in and this form must be submitted to the SGA Office before the date listed on the SGA Website where this form was downloaded. If you have any questions, please or call (434) before the submission deadline. Please note that completing and submitting this form does not guarantee nor imply that your club will receive a donation. Clubs should also seek separate sources of revenue, such as fundraisers, along with this request as SGA cannot fully donate to any club. Club Name Club Treasurer Club President Treasurer Phone Has the current Club President ever had a check written to him or her by Liberty University? Yes No Treasurer ID # Has the current Club Treasurer ever had a check Address written to him or her by Liberty University? Yes No 1. List the amount of SGA donation received last semester 2. List the amount of SGA donation used last semester 3. Total amount of SGA donation requested this semester (This must equal the amount listed on the bottom of page 3) 4. List any other revenue you expect to receive this semester, including the source and amount you expect to receive (e.g. Selling t-shirts, charging admission to a banquet, club membership fees, etc ) Source: Student Government Association Budget & Finance Committee Use Only Received on Reviewed on Approved Amount Fund Code Received by Fund Xfer on -1-

2 Budget Information Please fill in the following information to the best of your knowledge using estimates if necessary. Attach additional event request sheets if needed.you must also fill out the Event Request Form to provide an exact amount and breakdown of each individual event two weeks before donation is needed. 1 SAMPL Dinner/Banquet 10/05/ $750 Total : to showcase club to students and raise money for Liberty Details of the event: Banquet Godparent home as well as discuss upcoming pro-life events Food (Catered by Sodexo) Decorations Plasticware/Paper Products E $500 $75 $75 Flyers Advertising Event Door Prizes (Gift Certificates) $50 $50 Total : Details of the event: Total : Details of the event: -2-

3 Total : Details of the event: Total : Details of the event: Total : Details of the event: Total Amount Requested: -3-

4 Terms and Conditions Section One I. We, the undersigned, do hereby affirm that we are acting in an official capacity on behalf of the applying club. II. We realize that the submission of this form does not guarantee, nor does it imply, that the club will receive a donation. III. We release Liberty University, the Liberty University Student Government Association (SGA), and any member acting officially on behalf of the SGA or the University of all liability for any consequences resulting from donation delays. IV. We acknowledge the fact that the SGA reserves the right to audit any club, at any time, for any reason, in order to protect the assets and financial integrity of the club, the Student Government Association, and Liberty University. V. We understand that all contact with any of the Universityʼs Financial Departments must go through the Chair of the SGA Budget & Finance Committee to prevent confusion and maintain accurate records. VI. We understand that all expenditures must be approved in advance by the Budget & Finance Committee of the Liberty University Student Government Association as well as any applicable University department, including, but not limited to, Student Affairs, Financial Planning & Budgeting, Accounting, Accounts Payable, and Purchasing. VII. We understand that expenditures made without prior approval are a violation of the Universityʼs Purchasing Policy and may not be reimbursed. VIII. We acknowledge that SGA subsidizes each event individually on a case by case basis. While a lump sum may be deposited to the clubʼs account, these funds may only be used for approved events. This form is to allow SGA to review events and expenses in advance; a new form must be completed each semester funding is desired. IX. We agree to submit all receipts and unused cash from an event to the SGA within seven (7) days of the event; the returned cash will be deposited back into the clubʼs account. We acknowledge that failure to do so will result in financial review of the club which may include suspension of funds. X. We understand that while unused funds rollover within the academic year (from the fall to spring semester), they do not rollover from the spring to the fall semester. Any unused SGA funds will be withdrawn from the clubʼs account on this upcoming June 30; money received from other sources will remain in the account and roll over on June 30. XI. We realize that these Terms and Conditions may change at any time with fifteen (15) days written notice. XII. We hereby affirm that all information provided herein is, to the best of our knowledge, true and accurate. Club President Club Treasurer Print Name Print Name -4-

5 Terms and Conditions Section Two I. I, the clubʼs Faculty Advisor, agree that I have met with the Club Officers to review this Donation Request. II. I understand that I will be responsible for obtaining the approved donation, including submitting Encumbrances, Requisitions, and Request for Check forms using Banner INB. If I do not have access to Banner INB, I understand that I will be responsible for taking the appropriate Professional Development Classes (Finance 100, 200, and 205) found in the ProDev Portal on the Liberty University website and applying for and using a Purchasing Card. III. I also agree to the terms and conditions listed above in Section One. Club Faculty Advisor Print Name Advisor Phone Advisor SGA Budget & Finance Committee Use Only Received Total Amount Requested Reviewed Total Amount Approved Funds Transferred Individual Event Approvals and Denials Stipulations or Other Information Reviewal Notes and Voting Record Chair, Budget & Finance Committee Vice President for Student Services -5-