College of Medicine (Hershey Campus) Student Organizations Request to Purchase Goods

Name of Student Organization

Location of Student Organization (UP student organizations have a separate form to request purchase of goods)

Hershey

First and Last Name

Email

Date of the request

Date items are needed (must be at least 2 weeks from date of request)

Location the items will be used (i.e. on campus or off campus)

Does your organization have funding to support your purchase request?

YesNoI don't know

Source of funding:

General Fund AccountGift Fund AccountI don't know

YesNoI don't know

List of Items that you'd like to purchase

Total Cost of Items ($)

Web links to items you'd like to purchase

What will your purchase be used for and how will it further the mission of the group?