Retroactive DSA Event Funding Request Form
“The DSA Committee is empowered to issue SCSU budgeted
DSA Funding”
DSA Name: __________________________ Event Name: ______________________
DSA ID Number: ____________________ Date of Submission: ____/____/____
TYPE OF FUNDING
ACADEMIC EVENT (Fill out Event Information portion)
SOCIAL EVENT (Fill out Event Information portion)
*Please note that academic events will be given preference for funding.
Terms of Approval:
All funding requests are subject to the DSA funding operational
policy. This is available at https://scsu.ca/. Please read and have a
thorough understanding of it. Only recognized DSAs who have
successfully completed SCSU DSA Training will be considered for
funding.
1. Official DSA activity status is determined by SCSU DSA Training
attendance and the Department of Student Life’s campus group list.
2. DSAs must fully complete this package as well as attach all original
receipts for the event in which they are requesting funding. Any
submission for retroactive funds without receipts attached will not be
considered in the current round of DSA funding. SCSU reserves the
right not to issue DSA funding to students and DSAs who have yet to
submit their receipts.
3. Please allow up to three (3) weeks for a screening process. Any funding
request over $500.00 requires a 10 minute presentation from the DSA
to the DSA Committee. You will be notified after the screening with
either Approval, Partial or Refusal of funding.
4. DSA funding will only be issued to the official DSA name, as shown on
the DSA bank account. Funds will not be issued to any individual.
Primary Contact Information
Official DSA Name: ___________________________________________________________________
(as it appears on DSA’s bank account)
Official DSA Email: _________________________ DSA ID Number: ______________________
Contact Name: ________________________________________________________________________
Email of Contact: __________________________ Phone of Contact: ______________________
Position of Contact: __________________________________________________________________
Event Assessment
Name of the Event: __________________________________________________________________
Date of Event: ______________________________________________________________________
Event Start Time: ______________ Event End Time: _______________
Event Location: ___________________________________________________
Number of Students Attended
UTSC Students: _______________________
Non-UTSC Students: _____________________
Was there a fee for event participation? (This includes charging for food,
entrance, etc.) If yes, how much? __________________________________________________
_________________________________________________________________________________________
NOTE: It is a violation of the SCSU DSA Policy for DSAs to request a donation of any kind
prior to or after entering an event. Donations may only be given voluntarily by guests.
Event Assessment
What was the purpose of the event?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Describe how the event went overall:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
How did it benefit UTSC students? How did it fulfill your DSA’s mandate?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Describe your marketing plan and the avenues used to promote your event (Please attach a
sample of any posters, flyers, etc.)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Have you received, applied or are planning to apply for funding from any source other than
SCSU? (Ex. DSL, Dean’s office, your department, external funding etc.) If yes, please list source
and amounts:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Event Financials: Expenses
Expense Description
Supplier /Store / Entertainment
Total Expense:
Actual Amount $
NOTE: It is a violation of the SCSU DSA Policy for DSAs to claim charity donations on
their expense report. DSAs who fail to follow these guidelines will automatically have
their Funding Request denied until the appropriate adjustments are made.
Event Financials: Revenue/Funding
Income Sources
Actual Amount ($)
Total Income:
TOTAL EXPENSE (minus) – TOTAL INCOME = $ _________________________
TOTAL AMOUNT REQUESTED: $ ________________________________
Amount requested cannot exceed the difference between expenses & income.
If you have any questions please contact the VP Academics & University Affairs at
[email protected]
For Office Use Only
Total amount requested by DSA: $ ________________
Total amount approved by DSA Committee for reimbursement: $ ________________
SIGNATURE PAGE
Funding requests must be signed by two (2) signing officers of the DSA. Funding
requests without the signatures will not be reviewed.
___________________________
Name
_________________________
Position
___________________________
Signature
_________________________
Date
___________________________
Name
_________________________
Position
___________________________
Signature
_________________________
Date
Sample DSA Funding Form
Event Financials: Expenses
Expense Description
Supplier /Store / Entertainment
Actual Amount $
Venue Rental
“Hectic” Lounge (Security Included)
$1,000.00
DJs
DJ I-pod
$250.00
Transportation
Bus Co. (2 buses)
$430.23
Marketing Material
Printers Inc. (1 banner, 200 posters)
$97.89
Total Expense:
$1,778.12
Event Financials: Revenue/Funding
Income Sources
Actual Amount ($)
DSA Account
$100.00
Ticket Sales
$400.00
Department of Student Life Funding
$250.00
Sponsorship
$300.00
Other (ex. Alumni Donation)
$100.00
Total Income:
$1,150.00
TOTAL EXPENSE (minus) – TOTAL INCOME = $ _____$628.12_______
TOTAL AMOUNT REQUESTED: $ 682.12
Amount requested cannot exceed the difference between expenses & income.
Receipts
Improper Receipt:
Proper Receipt:
Please Note:
In order for your DSA Funding Request to be processed, it must have the
proper, original receipts attached to this form. The receipts must:
- Show the name and address of the establishment
- Show an itemized list of what was purchased and their price(s)
- Show payment verification
**only ORIGINAL RECEIPTS will be accepted**
2016-2017 DSA Funding Deadlines
DSAs must hand in their DSA Funding Request Forms and all original receipts prior to
these dates in order to be processed and considered for the round:
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Round 1: Application deadline on Thursday October 27th, 2016
Round 2: Application deadline on Thursday November 24th, 2016
Round 3: Application deadline on Thursday February 16th, 2017
Round 4: Application deadline on Thursday March 20th, 2017