ࡱ> 241Y bjbj h h 8kbkb dd,BBBB>[o BDDDDDD$m#!h{{{hBB}{ BBB{BjB Z6.0>,!v!j!j{{{{{{{hh |{{{{{{{!{{{{{{{{{dB : CLEVELAND STATE UNIVERSITY CONTROLLERS OFFICE STUDENT LIFE AGENCY ACCOUNT FORM ____ New Account ____ Renewal of Account ____ Change of Signature(s) NAME OF STUDENT ORGANIZATION ________________________________________ PURPOSE OF ACCOUNT ___________________________________________________ SOURCE OF FUNDS _____________________________________________ AUTHORIZED STUDENT OFFICER SIGNATURES: ____________________________________ _____________________________________ print name print name ____________________________________ _____________________________________ signature signature Address and Telephone: Address and Telephone: ____________________________________ _____________________________________ ____________________________________ _____________________________________ ADVISORS NAME (please print): _____________________________________________________ ADVISORS SIGNATURE: __________________________________________________________ My signature above confirms that I have agreed to serve as faculty/staff advisor for this student organization during the academic year. See Advisor tab on the Student Organizations website  HYPERLINK "http://csuohio.orgsync.com/Forms" http://csuohio.orgsync.com/Forms for advisor expectations and other useful information. TERMINATION INFORMATION: Use of this account will terminate on June 30th of the fiscal year at which time it may be renewed by filing a new Agency Account Form with the Controllers Office. If the account is not renewed, funds will be given to the Student Life Account. All Student Life Agency Accounts must be sponsored through the Student Life Department. The Student Life Department will monitor and approve all expenses to this agency account. APPROVALS: Student Life Representative: ______________________________________________ Date: _______ Dean of Students: _________________________________ Account Number: ___________________________ Date Approved by Controllers Office: _________________ IMPORTANT NOTE: Student organizations that are inactive for one year must apply in writing to the Dean of Student Life, for reinstatement of its Agency Account funds. After two years of inactive status, Agency Account funds are confiscated by ϰϲʿ¼ϒs Student Life Department. /<OPR8 9 h s { [ \ & ' 5 } ɷrdUFhePh%IYCJOJQJaJhePh%IYCJOJQJaJhePh8,r5CJOJQJhePhzj$5CJOJQJhePh%IY5CJOJQJhePh8,rCJOJQJhePh%IYCJOJQJhePh%IYCJOJQJaJ"hh%IY9>*CJOJQJaJ"hh%IY59CJOJQJaJ"hh[59CJOJQJaJhePh%IY5OJQJ hePh%IY/PQRS( ) g h C [ \ @&$a$ $d @&a$gd:^ d @&gd:^ & ' | } V   6 -.KLd gd; hd ^hgd:^ & Fhd ^hgd:^ d @&gd;@&  ' C G T U V     베ևևp[F[6hePhzj$6CJOJQJaJ(hh\M06B* CJOJQJaJphS(hhA56B* CJOJQJaJphS,hh:^0J6B* CJOJQJaJphS1jhh:^6B* CJOJQJUaJphS"h 6B* CJOJQJaJphS"h#X6B* CJOJQJaJphS"h6B* CJOJQJaJphS(hh:^6B* CJOJQJaJphS(hhzj$6B* CJOJQJaJphS \ c e x -.:?L\^_hePh%IY5CJOJQJ\hePh8,rCJOJQJhePh%IY5CJOJQJhePh?CJOJQJhePh%IYCJOJQJaJhhCJH*OJQJhCJOJQJhePh%IYCJOJQJd gdzj$6P&P:p:^/ =!"#$% s2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH 8`8 Normal_HmH sH tH PP  Heading 1$<@&5CJKHOJQJDA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List 8>@8 Title$a$ 5OJQJ@Y@  Document Map-D OJQJ6U`6 :^ Hyperlink >*B*phFV !F ePFollowedHyperlink >*B*phPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w<        X8@0(  B S  ? _Hlt330300288 _Hlt330300289 @@    //99CGTVZZ\x //99CGTVZZ\x kO- h^`OJQJo(hHh^`OJQJ^Jo(hHohp^p`OJQJo(hHh@ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohP^P`OJQJo(hHkO-         +*#X[ LO?r:azj$y-"0\M0;eP>S%IY:^`,leQl8,r&/v!`wH@=G3I?A5VLT[L yH7>*n  @ @UnknownG*Ax Times New Roman5Symbol3. *Cx Arial5. .[`)Tahoma?= *Cx Courier New;WingdingsA$BCambria Math"hۢLGۢLGkZZ 24  3QHP?y-0!xx CLEVELAND STATE UNIVERSITYKathy StoessnerHolly A Elliott Oh+'0 $ D P \ ht|CLEVELAND STATE UNIVERSITYKathy Stoessner Normal.dotmHolly A Elliott2Microsoft Office Word@@N-1a@Z@ZZ՜.+,D՜.+,` hp  ϰϲʿ¼  CLEVELAND STATE UNIVERSITY Title 8@ _PID_HLINKSA|QA!http://csuohio.orgsync.com/Forms  "#$%&'(*+,-./03Root Entry FZ51Table!WordDocument8SummaryInformation(!DocumentSummaryInformation8)CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q