Name of Club: Select one... Am. Assoc of Un.Women American Marketing Association Alpha Chi Alpha Phi Omega American Institute of Graphic Arts ARMY ROTC Association of Computing Machinery Asso. For Sup. and Cur. Dev. Ballroom Dancing Club Beta Beta Beta (BETA) Biology Club Black Student Union Campus Activities Board Campus Crusade for Christ C.H.E.M. Club Chi Alpha Christian Fellowship Communication Connection Criminal Justice Club Dancing Pirates Debate Club English Club-Sigma Tau Delta Flying Disc Club GEO Club Global Future Healing Exp Arts Therapy Club International Interior Design Assoc Milele Kenya Club Model Organization of American States Model United Nations Muslim Student Association Park Student Gov't Association Park UCollege Republicans Park Univ Gay/Str All Pax Christi Pi Lambda Theta People to People International Phi Alpha Theta (Zeta Omicron) Pirate Grounds Pirate Radio Club Political Science Psi Chi Psychology Club Residence Hall Council Rotaract Sigma Alpha Pi Social Psych Club (online) Social Work Spanish Club Student Ambassadors Park University Student Athletic Trainers Association Student Nat'l Education Assoc. Student Nurses' Association Theatre Club World Student Union

Other Organization: (if not listed above)

Your Name: Required

Your Email: Required

Contact Name: Required

Contact Phone: Required

Contact Email: Required

Contact Student ID: Required

Advisor/Sponsor Name:

Advisor Park Box #:

Advisor Phone:

Name of Special Project:

Date and Time of Special Project:

Location of Special Project:

Description of Special Project (if attending a conference please email an agenda separately to senate@park.edu AND caroline.heckman@park.edu

Funds Outline

Amount Requested:

# Students Expected to Attend:

Amount per Student:

Associated Costs of Special Project:

Lodging: Per Student $:

Transportation: Per Student $:

Method of Transportation:

Food and Beverage: Per Student $:

Registration Fee: Per Student $:

Advertisement: Per Student $:

Miscellaneous Costs:

Total Cost of Special Project: Per Student $:

Will this event be limited to a select group of individual or opened up to the entire Park University Student Body?
Select Individuals Entire Student Body

How will the Park University Student Body benefit from this project?

Have you done any fundraising to fund this project? How much money have you raised?

If PSGA gives you less than the amount that you are requesting will you be able to fund this project?

Additional Comments:

Things to Remember When Filing a Funds Request:

• The person filling out the funds request should be present at the PSGA meeting to provide background information concerning the event and organization, as well as to answer any questions the PSGA may have.
• Please be as specific as possible when filling out the funds request form; all PSGA members receive a copy of this form at the meeting.
• All expenditures must include original receipt, cancelled check, or billing statement prior to money transfer.
• If funding request is approved by PSGA you will need to submit a one-page summary of the event.