Club Membership Dues Financial Support

Club Membership Dues Financial Support
Membership money will be disbursed as a reimbursement process.  Up to $15 per student will be allowed, funding permitted.  $4,000 of the Club Support budget is set aside for membership reimbursement for student to local, state, and natinal associations.  Last year, membership reimbursement was granted to over 500 students.
Date of Request
Club Name
Advisor Information
phone number
Email Address

Organization Joining

Name of Affiliation
City, State, Zip code
Phone number

Total Cost of Dues

Student Information

Total number of Studentsthat will be joining this organization
Student's Name and Student ID number

Please create this information as the following example:

Total Students 2

Jane Doe 1234567, John Smith 9876543

Total Amount Requesting

               Up to $15 per student