Club Funds Request "*" indicates required fields X/TwitterThis field is for validation purposes and should be left unchanged.Club Name3290 – Alpha Gamma Sigma3971 – BSU3017 – Chicanx/Latinx Conservation3195 – Creative Writing Club3962 – DSPS Student Council3020 – Foster Minds of Excellence3013 – Game Arts & Design3336.4 – Graphic Design Club3958 – Mock Trial/Pre-Law Society3973- New Music Collective3250 – Nursing Club (ADN)3260 – Nursing Club (NSNA)3116 – Psychology Club3122 – Puente Club3334 – QI3011 – Student & Parent Connect3118 – Victory ClubOtherOther: Enter Club Name*Account Number*Club Member InformationName First Last Email Club President InformationName First Last Email Date of Fund Request Notification Club Advisor InformationName First Last Email Date of Fund Request Notification Upload Meeting Minutes*Please upload minutes showing proof of approval Drop files here or Select files Max. file size: 50 MB. Was quorum present?*Quorum includes 50%+1 eligible members on the official club roster; official meetings without quorum are prohibited. Yes; Quorum was present – request is eligible to process No; Quorum was not present – request is NOT eligible to process Number of Eligible Members Present*Sign-in Sheets may be requested for final approval Number of YES votes*Sign-in Sheets may be requested for final approval Number of ABSTAIN votes*Sign-in Sheets may be requested for final approval Type of Request* Cash Advance – Check made out to Advisor Only (Must be completed at least 4 weeks in advance Reimbursement – Requires Original Itemized Receipts Only; clubs should pay to third-party vendors whenever possible (Provide receipts to ICC Advisor) Pay Third-Party Vendor – Must include original invoice and W-9 for new vendors. All orders that do not have sales tax must have the amount accounted for in the quorum vote Please Describe the Request for FundsMake Check Payable to:Please enter the Amount RequestedPayee's Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Additional Supplemental Documents: Conference flyer, agenda or quote Drop files here or Select files Max. file size: 50 MB. Third Party Vendor Invoices Drop files here or Select files Max. file size: 50 MB. Scan and upload receipts, but you must submit original receipts to ICC Advisor after submitting this form Drop files here or Select files Max. file size: 50 MB. Terms & Conditions*I affirm that the information I have submitted is correct and true. I understand that providing false information may result in the Club’s account being frozen, the club being suspended, and possibly individual consequences. I Agree
