FSA Deposit Form

SUNY College of Optometry

Faculty Student Association Deposit Form

To: Erin Angarola, College Bursar From: ______________________ Date: _______________________ Please deposit the following into the Faculty Student Association bank account, as indicated below: Cash- Coin _____ $1’s ____ $5’s _____ $10’s ____ $20’s ______ Other _______ Sub-total Cash $________ Checks- # of checks _____ Value of Checks $________ Total Deposit for ____________________________________________ $____________ (specify name of program, fund-raiser, professional society, etc.) Source of Funds ( please check one) Contributions (5810) ____ Membership Dues (5850) _____ Program Fees (5820) _____ Cap & Gown (5880) _____ Yearbook (5890) _____ Fund Raising (5860) _____ Organization (please check one) Class of _____________ CTSAO - Connecticut (FCTS) AOSA (FAOS) Lion's Club (FLEO) APHA (FAPH) NOSA (FNOS) BSK (FBSK) NYSOA (FNYS) COSA - California (FCOS) SAAO (FSAA) COVD (FCOV) SOAPP (FPPC) CSA / CAOS - Canadian (FCSA) Student Council (FSTU) Residency (FRES) SVOSH (FSVO) FCO (FFCO) EyeBall (FEYE) Graduate Class (FGRA) NORA (FNOR) Gold Key (FGOL) CLEAR (FLCA) CCOSA - Chinese (FCCO) Vision Walk (FWLK)

________________________________________ ____________________________

Authorized Signature of Organization/Class Officer

Date

___________________________________________________________________

Vito J. Cavallaro

Date

030316