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)___________________________________________