Fundraising Activity Request
Printable Form

Please submit completed form to the Vice President of Student Services if requestor is a student organization, or to the Dean of Instruction or Vice President of Academic Affairs if requestor is an employee group, before submitting it to the Executive Director of the LCC Foundation/Director of Public Relations. Form must be in the Foundation office at least ten school days prior to the start of the proposed fundraising activity.

All Printed material, such as posters, ads, flyers, etc., for the activity must be reviewed by the Director of Public Relations before distribution to the public.

DATE OF REQUEST__________________________________

This request is for     __ a student organization     __ an employee group

Organization or group requesting approval___________________________________________

State the benefits that will result from the fundraising activity. Example: Purchase new furniture and new television set for the student lounge _________________________________________

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Describe the fundraising activity__________________________________________________________

____________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________

Date(s) and location of the fundraising activity________________________________________

______________________________________________________________________________

Please list all businesses that are going to be asked for donations of either merchandise or services for this fundraising event:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

*During the spring semesters, closer scrutiny will occur for requests to ask for donations from area businesses due to the Annual LCC Foundation Auction for Scholarships.

If a commercial vendor is participating, please complete the following:

Name of vendor_________________________________________________________________

Address_______________________________________________________________________

City_________________________________________State__________Zip________________

Telephone Area Code and Number__________________________________________________

What fee or percentage will the vendor pay to the student organization or employee group and how will it be paid? _____________________________________________________________

____________________________________________________________________________________________________________________________________________________________

Expected Revenues                                                    $__________                           

Expected Expenditures                                                                        

            Printing           $__________                                                    

            Postage            $__________                                                    

            Supplies           $__________                                        

            Telephone        $__________                                       

            Mileage           $__________                                          

            Other               $__________                                      

                   Total Expected Expenditures    - $__________                           

                                           Expected Net Income      $__________                           

Cash on hand for up-front expenditures $__________

________________________________________________________________________

Requestor’s signature              Requestor’s position with the student                          Date

 organization or employee group

________________________________________________________________________

Vice President’s signature                                                                                           Date

________________________________________________________________________

Executive Director’s signature, LCC Foundation                                                       Date

Revised:  7/19/06