BA-6313.1A --------------------, 2012

Once approved, a copy of this form must be maintained and available during fundraiser.

FUNDRAISING REQUEST FORM
(For Fundraisers by Student, Departmental, Employee Organizations and/or Entities)

Date        

Host Sponsor (Name of Your Department, Division or Organization)

Host Sponsor’s Primary Contact Name/Title:

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Phone:               Email:  

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Sponsoring Campus/Site:          

Purpose and Description of the Fundraiser:

Date(s) of Fundraiser:

Location of Fundraiser (If off-campus include name of location, address and contacts):

Vendors to Be Solicited:

REQUESTED:      ______________________________________________

       Signature of Host Sponsor      Date

FUNDRAISER APPROVED:  ______________________________________________
       Signature of Campus Executive Dean    Date

Copies to Host Sponsor; Office of Institutional Advancement

- - - - - - - - - - - - - - - - - - - - - -  For Office of Institutional Advancement Use - - - - - - - - - - - - - - - - - - - - - - - -

Received by Office of Institutional Advancement: __________________________ (Initials/Date)

Name/Contact of Actual Vendors Solicited (regardless of amount collected or if no contribution): ____________________________________________________________________________________________

____________________________________________________________________________________________

Amount Raised: __________________    Initials/Date: _____________

Form 6313/002 (2/13)

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