SCORE

Office of Multicultural Life SCORE

Student Club & Organization Request for Expense
Name*

First NameLast Name
Email*
example@muhlenberg.edu
I am...*

Requesting funds from Office of Multicultural Life as an individual or clubRequesting funds from my club's fundraising accountSeeking permission to make a purchase on my own for my clubSubmitting a receipt for reimbursement

SCORE

Payee Information
I am requesting...

An online purchase or paymentA credit card payment via phoneA check
Which office or department needs to be paid?

TransportationPrint Shop/Copy CenterOther
Department Account Number
Copy and paste the web address for your purchase
Attach a screenshot of the item(s) that need to be purchased

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Please detail any other information that would be helpful to make the purchase easier
Your items will be shipped to the Office of Multicultural Life.

You will be notified at your email address upon delivery.
Company Name
Company Contact Person
Company Phone Number
Invoice or Reference Number
Pay to the Order of:*
First and Last Name or Name of Business
Student ID Number
Permanent Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Method of Check Receipt:

Hold check for pickupMail check
To pay an individual, you must submit a signed contract. Contracts over $1,000 need to be signed by Jason Feiertag. Contracts under $1,000 can be signed by Robin Riley-Casey.

Please have these signatures before submitting the SCORE form. If your club or organization is paying a person for services (student or non-student), a W9 will also need to be filled out by the person being paid.

The W-9 MUST be uplaoded to our secure portal.

Instructions on how to do this can be found here.

DO NOT attach W-9 to this form for security purposes.

No payment will be issued until a W-9 Form has been received by the Business Office
Attach Your Receipt

DO NOT upload W9
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Attach Invoice, Bill, or Contract (DO NOT upload W9)

Cancelof
OML Email
SGA Emails
Accounts Payable Email
Transfer Email

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Requester's Approval
Your Initials:*
Note: initialing here acts as your signature
Date*

MonthDayYear
Today's Date

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Club Advisor's Approval
Do you approve of this request?*

YesNo
Please explain
Affinity Advisor Name:*

First NameLast Name
Affinity Advisor's Initials:*
Note: initialing here acts as your signature
Date*

MonthDayYear
Today's Date

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Office of Multicultural Life Approval
Do you approve of this request?*

YesNo
Please explain
Berg ID for Check
Notes
Office of Multicultural Life Name:*

First NameLast Name
OML Initials:*
Note: initialing here acts as your signature
Date*

MonthDayYear
Today's Date
Send Request to:

Accounts PayableCashierEmployeeSGAOML
Employee Email
Should be Empty:

Office of Multicultural Life SCORE

Student Club & Organization

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