Request to Create Account

BA-6313.1 --------------------, 2007

Request to Create Account

Name of Organization/Entity: _____________________________ Date: _________________

Type of Account: _____ Student _____ Faculty/Staff

Source of Funds: Type of Expenditures:
_____ Fundraisers _____ Services
_____ Dues _____ Supplies
_____ Donations _____ Travel
_____ Other: ______________________ _____ Other: ______________________

Please provide the name and operator number for processing requisitions (if applicable):

Enter requisitions: ___________________________
Approve requisitions: ___________________________

The Controller’s Office will deposit and disburse funds in accordance with established policies and procedures of Delgado Community College. The Controller’s Office will return any request for funds in excess of available balances.

______________________________________________________________________________
Signature of club/group representative Print Name Title with club/group

______________________________________________________________________________
Signature of faculty/staff advisor (if applicable) Print Name Title

APPROVALS:
For Student Accounts:

__________________________________________________________ ______________
Campus Chief Student Life Officer Date

__________________________________________________________ ______________
Campus Executive Dean Date

For Faculty/Staff Accounts:

__________________________________________________________ ______________
Appropriate Campus Executive Dean Date

______________________________________________________________ _____________
Controller Date

Controller’s Office use only: Date received:
Acct. # assigned: Date completed:


	Form 3330/001 (6/12)

Copy: Office of Institutional Advancement