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Activities Fees Check Request Form
Please note that appropriate time (3-5 Business Days) must be Given for the VP of Finance to Cut the Check
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* Indicates required question
Person Requesting (Full Name)
*
Your answer
Mobile Phone Number
*
Your answer
E-Mail
*
Your answer
Student Organization or Club
*
Your answer
Club Level (if applicable)
*
Level 1
Level 2
Level 3
Other:
Payable To + Address Example
Michael Dietzen
1234 Hiram Drive
Hiram OH, 44234
Payable To + Address
*
Your answer
Amount ($0.00)
*
Your answer
What Will Check Be Used For?
*
Your answer
First Club Officer/Student Signature
*
Sign with your electronic signature below: "Student Name"
Your answer
Second Club Officer Signature
Required for Amounts over $50
Your answer
Faculty/Staff Advisor Signature
Required for Amounts over $200
Your answer
Select Check Form of Delivery
*
The VP of Finance Will Email or Text You When your Check is Ready
Check Needs to Be Mailed
Check Will Be Picked Up From the Student Senate Office in Bates Hall
Required
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