Name of Club: Select one... ALPHA CHI (CHAPTER: MISSOURI THETA) ALPHA KAPPA DELTA ALPHA LAMBDA SIGMA BETA BETA BETA LAMBDA ALPHA EPSILON-CRIMINAL JUSTICE CLUB PHI ALPHA THETA/ZETA OMICRON PI LAMBDA THETA PI SIGMA ALPHA (ALPHA DELTA UPSILON CHAPTER) PSI CHI SIGMA ALPHA PI (National Society of Leadership & Success) SIGMA TAU DELTA-THE ENGLISH CLUB ASSOCIATION FOR COMPUTING MACHINERY (ACM) ASSOCIATION FOR SUPERVISION AND CURRICULUM DEVELOPMENT (ASCD) BIOLOGY CLUB C.H.E.M. CLUB COMMUNICATION CONNECTION GAIA EARTH CLUB MARTIAL ARTS CLUB MATH CLUB MODERN LANGUAGES CLUB PAINTED PIRATES PARK UNIVERSITY STUDENT ATHLETIC TRAINERS' ASSOCIATION (PUSATA) PHILOSOPHY CLUB POLITICAL SCIENCE CLUB PSYCHOLOGY/SOCIOLOGY CLUB SOCIAL WORK CLUB STUDENT NATIONAL EDUCATION ASSOCIATION (SNEA) STUDENT NURSES' ASSOCIATION (SNA) STUDENTS IN INTERIOR DESIGN THEATRE CLUB AMERICAN ASSOCIATION FOR UNIVERSITY WOMEN (AAUW) PARK STUDENT ACTIVITIES BOARD (PSAB) COLLEGIANS FOR SUCCESS SPECTRUM FLYING DISC CLUB PARK STUDENT GOVERNMENT ASSOCIATION (PSGA) PARK SERVICE ORGANIZATION THE PEACE EDUCATION CLUB PIRATE RADIO CLUB (KGSP 90.3 FM) RESIDENCE HALL COUNCIL (RHC) ROTARACT STUDENT AMBASSADORS STUDENT VETERANS OF AMERICA GLOBAL FUTURE MILELE KENYAN CLUB MODEL ORGANIZATION OF THE AMERICAN STATES CLUB (MOAS) MODEL UN PEOPLE TO PEOPLE INTERNATIONAL WORLD STUDENT UNION (WSU) CHI ALPHA CHRISTIAN FELLOWSHIP MUSLIM STUDENT ASSOCIATION PAX CHRISTI REVIVE/CAMPUS CRUSADE FOR CHRIST OTHER

Other Organization: (if not listed above)

Your Name: Required

Your Email: Required

Contact Name: Required

Contact Phone: Required

Contact Email: Required

Contact Student ID: Required

Advisor/Sponsor Name:

Advisor Park Box #:

Advisor Phone:

Name of Special Project:

Date and Time of Special Project:

Location of Special Project:

Description of Special Project (if attending a conference please email an agenda separately to senate@park.edu.

Funds Outline

Amount Requested:

# Students Expected to Attend:

Amount per Student:

Associated Costs of Special Project:

Lodging: Per Student $:

Transportation: Per Student $:

Method of Transportation:

Food and Beverage: Per Student $:

Registration Fee: Per Student $:

Advertisement: Per Student $:

Miscellaneous Costs:

Total Cost of Special Project: Per Student $:

Will this event be limited to a select group of individual or opened up to the entire Park University Student Body?
Select Individuals Entire Student Body

How will the Park University Student Body benefit from this project?

Have you done any fundraising to fund this project? How much money have you raised?

If PSGA gives you less than the amount that you are requesting will you be able to fund this project?

Additional Comments:

Things to Remember When Filing a Funds Request:

• The person filling out the funds request should be present at the PSGA meeting to provide background information concerning the event and organization, as well as to answer any questions the PSGA may have.
• Please be as specific as possible when filling out the funds request form; all PSGA members receive a copy of this form at the meeting.
• All expenditures must include original receipt, cancelled check, or billing statement prior to money transfer.
• If funding request is approved by PSGA you will need to submit a one-page summary of the event.