To Be Filled Out By Student Group Representative:Name of Student Group: Name of Event/Program: Date of Event: Department: 4560 Project: AG00 or UR00

Source of Funds: (Check all that apply)

Amount: Ad Sales: Attach documentation showing fee structure/price listExternal Sponsorship: Attach contract, agreement or sponsor letter. Sponsor name: Fundraising, On-Campus: (ex: bake sales, merchandise sales collected on the Lerner ramps) Fundraising, Other: (specify type of fundraising and method of collecting funds) Membership Fees: Attach fee structure/price list and proposed usage for collected funds Participation Fees for an Event: Attach documentation showing fee structure/price list and budget for the event Ticket Sales: Attach documentation showing price list and printout from Eventbrite or Bedework Other: Specify source of funding in detail

REMINDER: Funds can not be collected using Venmo, PayPal, GoFund Me or other third-party apps or platforms.

Date Description of Item(s) Sold or Funds Received Source of Funds Amount

Total Collected:

Adviser Signature: Note to adviser: Please ensure all fields are complete and supporting documentation is attached and reviewed prior to signing.

Date:

By signing below both administrative staff and group representative acknowledge deposit received.

Group Representative Name:

Administrative Staff Name:

UNI:

UNI:

Signature:

Signature:

Cash Deposit Form, 12/2018

Check Amount Quantity Total

Grand Total:

Once adviser signature has been obtained, bring this signed form and the deposit to USL Administration & Planning, Lerner Hall 510.

Refer to List Above

Please note: A separate form must be filled out for cash and checks. Please use the Cash Deposit Form if you wish to deposit cash.

Student Group Check Deposit Form Undergraduate Student Life

Please use additional sheet if more lines are needed for itemized checks.

Office Use Only:

Subtotal: $

Total Bank Returned: $

Total Deposit (Subtotal Less Total Bank): $