Instructions for completing the general agency application form:
(1) The name of the Faculty Sponsor
(2) Date when the form was filled out
(3) A complete name of the Agency
(4) Faculty sponsor information
(5) Name and Agency Title of the Faculty Sponsor
(6) Name and Agency Title of the Agency's Officer whose name may be on the
Signature Authorizations Form
(7) Additional people who may be on the Signature Authorizations Form
(8) A brief statement explaining why the Agency has been established and how the funds will be used
(9) The type of deposits (check, cash, etc.) and how these funds are obtained (dues, bake sale, etc.)
(10) Estimated number and dollar amount of deposits per month
(11) Dean of Students authorization is required for all student agencies
Any questions regarding this form may be addressed to ext 5261.
TO: A/P Specialist
FROM: (1)________________________________________
DATE: (2)________________________________________
SUBJECT: REQUEST TO OPEN A "GENERAL AGENCY ACCOUNT"
NAME OF ORGANIZATION: (3)______________________________________________
Faculty Sponsor: (4)_______________________________________________
Name Campus Address
_________________________________________________
Telephone Extension Email
ADMINISTRATORS:
(5)
_______________________________________________________________________
Name Title
(6)_____________________________________________________________________
Name Title
(7)
_______________________________________________________________________
Name Title
A brief statement of organization's structure, membership purpose and relationship to Northern Kentucky University. (Indicate dates "FROM" and "TO" for temporary accounts.)
(8)______________________________________________________________
________________________________________________________________
________________________________________________________________
Type (source) of funds to be deposited with Student Account Services:
(9)______________________________________________________________
Estimated monthly deposits: Number (10)_____________Dollar Amount___________
___________________________________
APPROVAL FOR STUDENT ORGANIZATIONS
(11)___________________________________________
