Request to Create Account

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 Provost Date

For Faculty/Staff Accounts:

__________________________________________________________ ______________

Appropriate Campus Provost Date

______________________________________________________________ _____________

Controller Date

Controller’s Office use only: Date received:

Acct. # assigned: Date completed:

Form 3330/001 (7/07)

Copy: Office of Resource Development