USG - CSV Information Form

CSV Information Form

Undergraduate Student Goverment
Thank you for taking the time to fill out the CSV Information Form!

In order to receive an electronic payment of a reimbursement, we must have this information on file. You can still choose to receive your reimbursement as a physical check.

When receiving an electronic payment for reimbursement, you will receive an email called Client Name. For more information about USG please visit stonybrookusg.com
Name*

First NameLast Name
Full Name
Enter your First and Last Name (e.g. John Smith)
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Number and Name or Apartment or Unit and Number

Apartment or Unit and Number

CityState

Zip Code
Should be Empty: