Donation Request Form
Print Form
Donation Request Form ATHLETIC COMPLIANCE OFFICE
Instructions: Please complete this form and submit to the Marketing Department at least four (4) weeks prior to the date of the event. This form (along with a copy of the flyer, brochure, or letter describing the event) may be returned directly to the Marketing Department, or it may be mailed to the address listed below.
Name of Organization:
Phone
Name of Representative
Email:
Address City:
State:
Your Organization is:
Zip Code:
Educational/ Scholastic Related Non-Profit/ Charitable Organization - 501(c)3 documentation must be included Other- Please describe:
Is required information (e.g. flyer, brochure, letter) included?
Yes
No
Yes
No
Reason the item is being requested (fund raising, auction, door prize, etc.): Proceeds from event/project will be used for: Will high school-age students (9th-12th grades) benefit?
Item Requested:
Tuke Autographed Football ($25 charge)
Rick Ray Autographed Basketball ($25 charge)
Football Tickets (Select Dates) Other- Please Specify:
Basketball Tickets (Select Dates)
Date of Event/Activity:
Date Needed By:
I confirm my knowledge of the NCAA rules and regulations pertaining to this request and agree to abide by all said guidelines. I understand that Southeast Missouri State University reserves the right to request the item requested when guidelines are not followed.
Signature of Representative
Date Marketing Approval
Donation Request Approved?
Yes
Marketing Signature
Date Compliance Approval
Compliance Signature
Date Southeast Missouri State University Attn: Marketing Department One University Plaza, MS 0200 Cape Girardeau, MO 63701
*If questions arise or anything listed on this form changes, please contact Alex Lais at: (573) 986-6139.*
No
Donation Request Form ATHLETIC COMPLIANCE OFFICE
Instructions: Please complete this form and submit to the Marketing Department at least four (4) weeks prior to the date of the event. This form (along with a copy of the flyer, brochure, or letter describing the event) may be returned directly to the Marketing Department, or it may be mailed to the address listed below.
Name of Organization:
Phone
Name of Representative
Email:
Address City:
State:
Your Organization is:
Zip Code:
Educational/ Scholastic Related Non-Profit/ Charitable Organization - 501(c)3 documentation must be included Other- Please describe:
Is required information (e.g. flyer, brochure, letter) included?
Yes
No
Yes
No
Reason the item is being requested (fund raising, auction, door prize, etc.): Proceeds from event/project will be used for: Will high school-age students (9th-12th grades) benefit?
Item Requested:
Tuke Autographed Football ($25 charge)
Rick Ray Autographed Basketball ($25 charge)
Football Tickets (Select Dates) Other- Please Specify:
Basketball Tickets (Select Dates)
Date of Event/Activity:
Date Needed By:
I confirm my knowledge of the NCAA rules and regulations pertaining to this request and agree to abide by all said guidelines. I understand that Southeast Missouri State University reserves the right to request the item requested when guidelines are not followed.
Signature of Representative
Date Marketing Approval
Donation Request Approved?
Yes
Marketing Signature
Date Compliance Approval
Compliance Signature
Date Southeast Missouri State University Attn: Marketing Department One University Plaza, MS 0200 Cape Girardeau, MO 63701
*If questions arise or anything listed on this form changes, please contact Alex Lais at: (573) 986-6139.*
No
