FOUNDATION

CSUN FOUNDATION
TEL NO: (818) 677-4657
FAX NO: (818) 677-4823
MAIL DROP: 8296
Check Request Form
Date:
Reference #:
Amount: $
Amount in Words:
Payee Name: Mail Drop:
Payee is:
FACULTY STATE/UNIV CORP EMPLOYEE CSUN STUDENT OTHER
Payee Address:
Brief Explanation of Expenditure: (must relate to account purpose)
Charge to Fund Name:
ACCOUNT:
FUND:
DEPT ID:
PROGRAM:
CLASS:
PROJECT/GRANT:
NACUBO Classification: INSTRUCTION RESEARCH PUBLIC SERVICE
ACADEMIC SUPPORT STUDENT SERVICES INSTITUTIONAL SUPPT SCHOLARSHIPS
(PLEASE CONSULT YOUR MAR/FINANCIAL MANAGER TO ENSURE THESE BOXES ARE CHECKED CORRECTLY)
This Check Should Be: MAILED TO PAYEE HELD FOR PICKUP CSUN MAIL DROP
Questions? Please call:      
NAME OF CONTACT PERSON: PHONE: EMAIL: MAIL DROP:

Signature: ______________________________________________  
Print Name: Date:
Signature: _______________________________________________  
Print Name: Date:
Signature: _______________________________________________  
Print Name: Date:
Reviewed By: __________________________________ Check Received By: __________________________________
IMPORTANT: ORIGINAL RECEIPTS AND INVOICES MUST ACCOMPANY EACH CHECK REQUEST. A W9 FORM MUST BE SUBMITTED FOR ALL NEW VENDORS. AN INDEPENDENT CONTRACTOR FORM MUST BE SUBMITTED WITH EACH REQUEST FOR SERVICES PROVIDED BY AN INDIVIDUAL OR UNINCORPORATED COMPANY. FOR REIMBURSEMENTS FOR EVENT RELATED EXPENSES, PLEASE INDICATE THE PURPOSE OF THE EVENT, THE DATE, A LIST OF ATTENDEES, AND ATTACH A COPY OF THE INVITATION/FLYER. FOR HOSPITALITY EXPENSES OVER $500, COMPLETE THE HOSPITALITY EXPENSE FORM. FOR AN INVOICE PAYMENT REQUEST, PLEASE MARK THE INVOICE "RECEIVED" WITH SIGNATURE AND DATE. FOR ALL SCHOLARSHIPS AND STUDENT AWARDS, PLEASE USE THE DEPARTMENT REQUEST FOR FUNDS FORM FOUND ON THE FINANCIAL AID WEBSITE. (1/10/05)