Section A: Requestor's Info
Full Name
*
First Name
Last Name
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Affiliation
*
SUA
SCOC
Position
*
Section B: Event Details
Event Name
*
Event Start Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Event End Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Event Time
*
Event Location
*
Number of Participants
*
Please give estimate.
Section C: Vendor Info
Vendor/Business Name
*
Write the official name that you want on the check.
Vendor On/Off Campus
*
Off Campus
On Campus
Vendor/Business Phone Number
*
-
Area Code
Phone Number
Is the Vendor/Individual a current University employee?
*
Yes
No
Was the Vendor/Individual a University employee at any time during the last two years?
*
Yes
No
Previous employee Job Title & the name of the office s/he worked for
Complete if the vendor/individual was a UCSC employee at anytime during the last two years.
Is the Vendor/Individual in the UC's vendor database (has vendor accepted POs for previous transactions)?
*
Yes
No
Vendor/Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Vendor/Business Contact Person
First Name
Last Name
Vendor/Business E-mail
Section D: Goods/Services Details
Transaction Type
*
Supplies, equipment, &/or tangible goods
Food &/or beverages
Services - Paying a business
Services - Paying an individual
TAPS Parking Permit
Pay on campus unit for goods/service (Indicate the unit's FOAPAL below.
Membership/Dues - (Attach a complete Direct Payment Form to this PO)
Charter bus (This PO goes to Sayo after Chair signs it.)
Reimbursement - Food
Reimbursement - NonFood (Attach Direct Payment Form)
University Catering - Online Recharge
Non-SOFA Funding Award
Describe the goods and/or services requested. (If this is a funds transfer, please indicate the receiver's FOAPAL in the box)
*
What's the purpose of the goods/services requested?
*
How will you obtain the final product?
*
Pick up the items in person
The business/individual will deliver or make the product available
N/A
PO/Recharge Needed by:
*
-
Month
-
Day
Year
Date Picker Icon
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Special Stipulation or Instructions
*
Fund 1
*
Org Code 1
*
Account 1
*
Activity 1
*
Amount 1
*
Fund 2
Org Code 2
Account 2
Activity 2
Amount 2
Section E: Supporting Documents
Attach 204 Form
Upload a File
To add pay a new vendor
Cancel
of
Attach Food Permit
Upload a File
If you're requesting food or beverages
Cancel
of
Attach Quote
Upload a File
If you're requesting a service
Cancel
of
Attach Scope of Service
Upload a File
If you're requesting a service from a vendor other than Barrios Unidos
Cancel
of
Attach Pre-Hire Worksheet
Upload a File
If you're paying an individual for a service
Cancel
of
Attach Waiver
Upload a File
Cancel
of
Attach Flyer
Upload a File
Cancel
of
Attach Attendance List
Upload a File
Cancel
of
Attach Shopping List (excel)
Upload a File
Cancel
of
Attach Complete Direct Payment Form
Upload a File
Cancel
of
Attach Event Invitation (Email or Flyer)
Upload a File
Cancel
of
Attach Direct Payment Form
Upload a File
Cancel
of
Attach SOAR Event Proposal Form
Upload a File
Cancel
of
Attach University Catering - Event Order (Official Quote w/ ID#)
Upload a File
Cancel
of
Important Correspondences
Upload a File
Cancel
of
Section F: Confirmation of Understanding: Purchase Process
I understand that I must attach all supporting documents in order for this form to be complete.
*
Initial here
I will acquire an itemized receipt from the vendor immediately after making the purchase & write the PO # on top of the receipt.
*
Initial here
Within 3 days of purchase, I will contribute to tracking my expenses by scanning the itemize receipts, uploading them the receipts folder, & recording the transaction in my g'doc spreadsheet.
*
Initial here
Within 3 days of purchase, I will turn in the original itemized receipt(s) into LaTrice's Box
*
Initial here
I understand that reimbursements for services violate UCSC policy, and that if I pay 'out of pocket' , neither the SUA nor UCSC will reimburse me for the expense.
*
Initial here
My initials & student ID # certify that I reviewed the budget & there's enough money to cover this expense.
*
Submit
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