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Student Group Funds Request

$
Enter numbers only in US Dollars.
$
Enter numbers only in US Dollars.

By submitting this request, I certify the information I provided on and in connection with this form is true and correct to the best of my knowledge. I also understand that any false statements or deliberate omissions on this form may disallow my organization from future contributions. I agree to submit a post event report which includes no later than 30 days post event. Failure to submit a report may result in being barred from receiving futureĀ funds.