2024-2025 OSA Undergrad Payment Request Form

To be submitted PRIOR to agreeing to payment terms.

Your Name*

Your Pronouns

If you have any questions, please refer to the following website. https://lgbtc.vpul.upenn.edu/Pronouns/

Your Email*

Your Group Name*

Name of Financial Coordinator*

Select "Unknown" if you do not know.

Select

Type of Transaction*

Select or enter value

Event Date*

Type of Funding*

If you have funding for this event, you choose the source from the drop-down

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PennID

Contact Person Legal Name*

Individual Pronouns

If you have any questions, please refer to the following website. https://lgbtc.vpul.upenn.edu/Pronouns/

Vendor/Supplier Name*

Vendor/Supplier Address*

Vendor/Supplier Email*

Vendor/Supplier Phone*

Description and Business Purpose*

What are you buying and why (what program is it for, etc.)

Estimated Head Count*

Proposed Payment Amount*

Please review the Payment Level guide located on the SA website prior to submission. Provide any justification for the proposed payment amount level.

Department Budget Account/SAC Budget Category*

Notes

Please upload any funding quotes, invoices and or funding letters.

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