Withdrawal Form

Foundation Approval 1

example@example.com

Foundation Approval 2

example@example.com

Foundation Contact

example@example.com

President Name*

President Email*

example@example.com

Additional Forms if Needed:

WOU Sub W9

Direct Deposit Authorization

DO NOT SUBMIT W9 WITH YOUR WITHDRAWAL REQUEST. EMAIL THEM SEPARATELY TO CARRILLON@WOU.EDU USING GMAIL'S CONFIDENTIALITY MODE OR TURN THEM IN HARDCOPY.

FOLLOW THE LINK BELOW FOR A GMAIL CONFIDENTIAL MODE TUTORIAL.

Gmail Confidential Mode

Email of Person Preparing Form*

example@example.com

Person Preparing Form*

First NameLast Name

Phone of Person Preparing Form*

Please enter a valid phone number.

Foundation Fund Name & Number (5-digit number, NOT an index)*

Fund NameFund Number

Grant(s)

Are you withdrawing from multiple Funds?*

YesNo

Additional Foundation Fund Name & Number 1

Fund NameFund Number

Additional Foundation Fund Name & Number 2

Fund NameFund Number

Do you have authority to sign off on expenditures from this Foundation Fund? (OLD)*

YesNo

Is this an Athletics Fund?*

YesNo

Is the Fund related to a specific sport?*

YesNo

Is the Payee the Athletic Director?*

YesNo

Head Coach Name *

Head Coach Email*

Athletic Director Name *

Athletic Director Email*

Who has the authority to approve this expenditure?*

Authority's Name

What is their email?*

Authority's email

What are you requesting?*

Start Date*

Start of trip, event, etc.

End Date*

End of trip, event, etc.

Advance Reminder Date

Date

DISCLAIMER:

Cash advances must have receipts AND/OR leftover cash returned to the Foundation with a deposit form AND check stub within two (2) weeks of the end date.

Receipts + Cash MUST be equal or greater than the original amount requested.

Payee is a..?*

CASH ADVANCE/CASH BOX REQUESTS TO OUTSIDE PERSONS ARE NOT ACCEPTED. PLEASE SUBMIT REQUEST FOR STAFF, FACULTY, OR STUDENT PAYEE.

Name of Payee's Manager*

Manager's Name

Email of Payee's Manager*

example@example.com

Payee Name*

No employee may authorize a payment for themselves. The approval of a manger/superior is required. If payee is the head of their department and you are unsure who needs to approve, please refer to this org chart.

If payee has no superior besides President Peters, please Enter "Jesse Peters" and "president@wou.edu".

If you are still unsure, please contact Noah Carrillo at carrillon@wou.edu.

V#*

Student, Staff, or Faculty

Payee Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Payee Identification*

W9 WILL be sent to the FoundationW-8 (Foreign Vendors) WILL be sent to the FoundationW9 or W8 ALREADY on File WITH THE FOUNDATION

Delivery Method*

Pickup CheckMail CheckDirect Deposit

If you have not submitted a W9 or Direct Deposit Authorization for the payee before, you can find the forms at the links below:

W9 Form

Direct Deposit Authorization

Additional Delivery Instructions

DO NOT ATTACH W9, W8, or Direct Deposit Authorizations to this submission.

Those forms need to be turned in physically to the Foundation at the attention of Noah Carrillo or emailed directly to carrillon@wou.edu via Gmail Confidential Mode. Please follow the link below to see instructions on how to use Confidential Mode.

Gmail Confidential Mode

Payee's Email*

example@example.com

Index/V#/Org*

Receipt Date (earliest if multiple)

Invoice Date

Date

Invoice #

Amount of Expenditure*

Reason for Expenditure*

Supporting Documentation (Receipt, Invoice, etc.)

GL Fund Name & Number*

Fund NameFund Number

Additional GL Fund Name & Number 1

Fund NameFund Number

Additional GL Fund Name & Number 2

Fund NameFund Number

GL Coding*

Available Funds:*

Additional Notes

Payment #

SENSITIVE INFORMATION CERTIFICATION*

I certify that I have not attached any supporting documentation that includes sensitive information such as a W9, W8 or a Direct Deposit Authorization.

If supporting documentation with sensitive information is included in this submission, the submission WILL be rejected and deleted by the Foundation, and resubmission WILL be required.

Foundation Withdrawal Form