Student Government Association Funding Request Form Individual Student

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1 Date of Request: Date Received: Contac t Information Student s Name: G Number: Contact Phone: Contact Academic Advisor: Advisor Phone: Travel Request Advisor Name of Conference/Competition Event: Location: Date of Conference/Competition: Means of Transportation: Hotel/Accommodation: Number of Nights: Please attach your typed response to the following questions on a separate sheet of paper 1. How will your attendance of this conference/competition benefit the Missouri Western community? 2. What is the personal financial contribution (if any) you expect each participant to make? Additionally, the following documentation MUST be attached to this application in order for your request to be reviewed by the Financial Oversight Committee: a. Conference/competition itinerary and/or brochure describing the event in detail. b. Individual making request MUST complete a Release and Indemnification Agreement (Individual listed must be current Western student with a cumulative GPA of 2.25). c. A registration form for the conference/competition showing the exact cost and date of the event. d. An official cost of lodging from the lodging venue. Documentation must include name, address, phone number and exact cost of each room. e. The FOC follow up procedures requires the submission of all original receipts, bills, completed registration forms, invoices and a typed follow-up report summarizing the experience within two weeks of the event. You may also be required to share the knowledge and skills you gain at funded conferences/competitions with the Western campus community.

2 Description of Expenses Expense Category RSO s Contribution Expected SGA Contribution Total Preferred Payment Disbursement Method Transportation (Bus, Auto, Airfare) Lodging (Include tax) Conference/ Registration Fee Total Expenses $ $ $ Reimbursement (mileage or gas) SGA Credit Card (airfare or bus) Advisor University Credit Card (Advisor to charge SGA Account) Reimbursement (Hotel) SGA Credit Card (must call hotel and request Credit Card Authorization Form to turn in with fund request form) Advisor University Credit Card (Advisor to charge SGA Account) Reimbursement SGA Credit Card Advisor University Credit Card (Advisor to charge SGA Account) Total Amount Requested from SGA: If additional space is needed, please attach an additional sheet explaining funding needed and the source of funding.

3 Important Rules and Application Deadlines Student Government Association Complete funding requests and required documentation must be received by the SGA director of Finance at least one (1) month (21 classroom days) prior to the event for which funding is being requested. The FOC will only consider funding prior to the event. The student organization requesting funding may be requested to be present at the FOC meeting in which the funding request is considered. Complete information including addresses, printed cost for accommodations, conference registration receipts, and other necessary paperwork is needed before FOC will review an application. Paperwork must be turned into the Director of Finance, located in the Student Government office, Blum Union, room 217. NOTE: Failure to comply with required documentation will delay and/or invalidate funding request. Once paperwork is received, the SGA Director of Finance will set up a hearing with the Financial Oversight Committee to discuss your funding request. By signing this application it is understood that any misuse or misrepresentation of funding will result in the cessation of future funding. Moreover, funds that are misused or unaccounted for will be recovered by the SGA. I also understand that per Funding Act (Bylaw Article V) all applications must be received by the SGA, Director of Finance no later than one (1) month (21 classroom days) prior to the requested event. All applications will be rejected if this deadline is not met. It is the individual student responsibility to assure the application has been received. Applicants Signature: Academic Advisor Signature: Date: Date: Student Government Association Contac t Information Contact the Student Government Association by or by phone for any additional questions. Ask for the Director of Finance. Feel free to visit our website first at for helpful tools to fill out your application. Check the Finances and Legislative drop down lists. We have a PowerPoint about funding, the SGA Constitution and Bylaws, and other important information about your Student Government Association. FOC USE ONLY Ayes Nays Abstains Approved Amount: $ Signature Director of Finance Date

4 STUDENT TRAVEL POLICY FOR REGISTERED STUDENT ORGANIZATIONS, INDIVIDUALS, OR UNIVERSITY ORGANIZED SPONSORED EVENTS I. Policy Statement It is the policy of Missouri Western State University to promote safe travel by students to and from events and activities covered by this policy. This is in accordance to MWSU Travel Policy II. Scope This policy applies to the travel of enrolled undergraduate or graduate students to attend activities or events that are organized and/or sponsored by registered student organization, department or college, or faculty and staff at Missouri Western State University The types of activities and events covered by this policy, but not limited to, include course related field trips, recreational sports club trips, the activities of sponsored student organizations, and meetings of academic organizations where a student is officially representing the University. Students, participating in such activity, are expected to abide by the Student Conduct Code since they re representing the University. The policy does not apply to travel undertaken by students to engage in student-teaching. With regards to the travel, in accordance with our policy, the students own insurance policy serves as a primary policy for third party liability and physical damage to their vehicle. III. Definitions An organized event is one that is initiated, planned and arranged by a member of the University's faculty or staff, or by the members of a sponsored (registered) student organization, and is approved by an appropriate administrator. A sponsored event or activity is one that the University endorses by supporting it financially, or by sending students to participate in it as official representatives of the University. An enrolled student is one who has been admitted to and is attending classes at the University. An appropriate administrator is a Dean, Department Chair, or Director of an administrative unit, or their delegate. IV. Travel Authorization In order to assure that the events or activities that involve student travel are within the course and scope of the University's mission, and that student safety issues have been addressed, travel undertaken pursuant to this policy must

5 be authorized in advance by an appropriate administrator. In the event the travel is in question, paper work has not been completed, or the institution is closed due to inclement weather or travel advisory posted by the MoDOT or National Weather Service, the Vice President for Student Affairs or designee reserves the right to cancel the trip. A. To request authorization, members of the faculty, staff or sponsored student organizations who organize activities covered by this policy must submit a completed Student/Organization Travel Authorization form, along with the required documents and information, to the appropriate administrator for approval. The request must be submitted at least fifteen (15) working days in advance of travel to the activity or event. Request made less than fifteen (15) working days must state the reason for such late request. B. The following information/documents must be submitted: 1. A list of participants including their names, local addresses and phone numbers, and the names and phone numbers of persons to contact in case of an emergency. 2. The name and phone number for the responsible University employee(s) who will be available to the students at all time during the travel and activity. In case of emergency, the main contact for the University is the MWSU Police Department. 3. Copy of valid operators' licenses for any students who will operate vehicles. The operator(s) must be free of six or more traffic violation points under state law; any chargeable accidents within the past 24 months; any convictions for driving under the influence of alcohol or drugs or other major violations, such as reckless driving, hit and run, driving with a suspended license, or fleeing from a police officer. 4. In the event the travel requires vehicle carrying 16 or more passengers or weigh more than 26,000 pounds, the operator, by federal regulations, is required to hold a commercial license. 5. Completed and signed Release and Indemnification Agreements for each participant. C. When leading group trips, faculty/staff advisor should carry emergency contact. D. Faculty who teach courses that involve frequent field trips can collect the following information from students at the beginning of each semester and keep it on file with the appropriate administrator for use throughout a semester (This also applies to students and registered student organizations who frequently travel. The information collected will be destroyed at the end of each academic year): completed and signed medical authorization forms; completed and signed release and indemnification agreements (a single release and indemnification agreement may be used if a single description fits all the proposed trips); and Proof of a valid vehicle operator's license for students who will operate vehicles. E. When an RSO is traveling to a conference/competition an advisor is required unless it is a direct affiliation to the RSO (Example: Alpha Kappa Psi Regional or National Convention).

6 V. Travel by Motor Vehicle Student Government Association A. Compliance with Laws and Policies 1. Motor vehicles used for travel covered by this policy shall have a current proof of liability insurance card. B. Vehicle Operator Requirements 1. All students who will operate vehicles while engaged in travel covered by this policy must have a valid operator's license. 2. Operators of motor vehicles shall comply with all laws, regulations and posted signs or directions regarding speed and traffic control. Student is responsible for any legal issues arise from failure to observe regulations. 3. Operators shall drive no more than four (4) hours without a minimum rest stop of fifteen (15) minutes; 4. Operators shall drive no more than ten (10) hours in any 24 hour period; 5. A navigator shall be assigned for all trips that are scheduled to take more than six (6) hours; and the navigator shall remain awake while on duty. 6. Trips requiring more than ten (10) hours of driving time shall include overnight lodging. 7. Driving between 11 PM and 6 AM is prohibited, without prior approval of the appropriate administrative official. C. Safety Requirements for Both Operators and Passengers 1. Fatigue. In the event that the operator is experiencing sign of fatigues, such as forgetfulness, impaired decision making and communication, slower reaction times, staring ahead instead of scanning surrounding conditions, drooping eyelids, close calls, such as drifting into another lane or not maintaining a safe following distance, the operator must be replaced. 2. Seat Belts. Occupants of motor vehicles shall use seat belts or other approved safety restraint devices required by law or regulation at all times when the vehicle is in operation. Missouri Western State University recognizes that seat belts are effective in preventing injuries, and fatalities. Our students, faculty, and staff are important to us, and want to reduce the risk that, in the event of an accident, a passenger in injured or killed. Therefore, all students, faculty, and staff of Missouri Western State University must wear seat belts when operating a schoolowned vehicle rented by, leased by, chartered by, in the custody of, or any vehicle while on school business. All occupants also are to wear seat belts or, where appropriate, child restraints when riding in a school-owned vehicle or in a personal vehicle being used for school business.

7 3. Alcohol and Illegal Substances. Occupants of motor vehicles shall not possess, consume, or transport any alcoholic beverages or illegal substances. Alcohol beverages are not allowed on any vehicle owned by, rented by, leased by, chartered by, in the custody of, or under the control of Missouri Western State University at any time. Vehicle operators and passengers are responsible for ensuring that no alcohol is carried onto any vehicle under their control. This includes, but is not limited to, kegs, cases, cans, bottles, coolers, etc. Operators are not to drive under the influence of alcohol or drugs. (Refer to Alcohol and Illicit Drugs Policy) 4. Passenger Capacity. The total number of passengers in any vehicle at any time it is in operation shall not exceed the manufacturer's recommended capacity, or the number specified by University policy, or federal or state law or regulations, whichever is lowest. 5. Distractions. In order to reduce accidents, operators are not permitted to use cell phones, headphones, grooming, and reading. When using cell phones or eating, operators should pull over. 6. Trailers. While there may be times when towing trailers may be necessary, operators must adhere to state law requirements and be informed of the trailer safety, not limited, to matching towing vehicle and trailer; hitching, braking, and wiring; and tire safety. (See Towing a Trailer: Being Equipped for Safety) 7. Key Removal. Operators are to remove keys and lock the vehicle when it is left unattended. 8. Inclement Weather. Operators are to check the forecast prior to departing on trip. When there is travel advisory issued by Weather Services, the trip is to be postponed until the travel advisory is lifted. In the event that weather problems develop a trip, appropriate accommodations should be considered. 9. Emergency. In the event that an accident or collision does occur, each operator is required to take along an emergency kit and accident report. D. Travel by Rental Vehicle Rentals of vehicles to use for travel to activities or events covered by this policy are governed by the following guidelines. 1. Payment of Costs for Rental Vehicles a. Vehicle rental charges can be a) billed centrally to University Accounts Receivable; or b) billed directly to individuals renting the vehicle with submission for reimbursement. If the rental costs are to be centrally billed, it will be necessary for the driver to obtain a Purchase Order from the University's Purchasing Department prior to picking up the rental vehicle. b. If necessary, personal credit cards may be used to rent vehicles for travel covered by this policy, and cardholders will be reimbursed for appropriate and approved costs.

8 2. Insurance Coverage Student Government Association a. Western will NOT reimburse for supplemental liability protection insurance or any collision and loss damage waivers. E. Travel by Means of a Vehicle Owned or Leased Long-Term by the University In addition to complying with the general rules set out above, travel by means of a vehicle that is owned or leased long-term (for a period of more than one year) by the University must comply with the following requirements: 1. Employee Operators a. All operators of vehicles described in this section shall be on the payroll of the University. All operators must have a valid license for the operation of a particular vehicle. b. Employee who travels with students or sponsored student organizations must adhere to the Western Travel Policy F. Travel by Privately Owned Vehicles Non-owned autos 1. When requesting authorization for travel that involves the use of personally owned vehicles, the requestor, in addition to submitting the information described in Part IV, B, shall also submit a copy of a current liability insurance certificate for any vehicle to be used for the proposed travel. 2. In the event that vehicle is not owned by the operator(s), a written confirmation of the vehicle owner s permission to use it for the university activities. 3. The persons responsible for the proposed activity and travel shall inform students who will drive their privately owned vehicles that they should have personal liability insurance policy will cover any liability that may result from the use of the vehicle for the proposed travel. This means that if a claim arising out of an accident exceeds your policy limits, the University is not held liable for the excess costs. G. Volunteer Drivers and Passengers Non-student/non-employee drivers and passengers who accompany students on travel covered by this policy must sign the Release and Indemnification form prior to the trip. For Assistance Questions regarding this policy should be directed to the Director of Student Life

9 RELEASE AND INDEMNIFICATION AGREEMENT ADULT STUDENT PARTICIPANT: Name (last name first - please print or type) Address City, State, Zip Code DESCRIPTION OF ACTIVITY OR TRIP: MODE OF TRANSPORTATION: LOCATION(s) of activity or trip: DATE(s) of activity or trip: FROM, 20 TO, 20 I, the above named student, am eighteen years of age or older and have voluntarily applied to participate in the above Activity or Trip. I acknowledge that the nature of the Activity or Trip may expose me to hazards or risks that may result in my illness, personal injury or death and I understand and appreciate the nature of such hazards and risks. In consideration of my participation in the Activity or Trip, I hereby accept all risk to my health and of my injury or death that may result from such participation and I hereby release Missouri Western State University, its governing board, officers, employees and representatives from any and all liability to me, my personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to my property and for any and all illness or injury to my person, including my death, that may result from or occur during my participation in the Activity or Trip, whether caused by negligence of the Missouri Western State University, its governing board, officers, employees, or representatives, or otherwise. I further agree to indemnify and hold harmless the Missouri Western State University and its governing board, officers, employees, and representatives from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in the described Activity or Trip. I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR MY INJURY OR DEATH OR DAMAGE TO MY PROPERTY THAT OCCURS WHILE PARTICIPATING IN THE DESCRIBED ACTIVITY OR TRIP AND IT OBLIGATES ME TO INDEMNIFY THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY MY NEGLIGENT OR INTENTIONAL ACT OR OMISSION. Signature of Student Date Signature of Witness Date Printed Name of Student Printed Name of Witness Address (if different from Participant s address)

10 RELEASE AND INDEMNIFICATION AGREEMENT MINOR STUDENT PARTICIPANT: Name (last name first - please print or type) Address City, State, Zip Code DESCRIPTION OF ACTIVITY OR TRIP: MODE OF TRANSPORTATION: LOCATION(s) of activity or trip: DATE(s) of activity or trip: FROM, 20 TO, 20 I am the Parent/Guardian of the above-named Participant, who is under eighteen years of age and I am fully competent to sign this Agreement. I give permission for Participant to participate in the above-referenced Activity or Trip. I acknowledge that the nature of the Activity or Trip may expose Participant to hazards or risks that may result in Participant s illness, personal injury or death and I understand and appreciate the nature of such hazards and risks. In consideration of Participant being permitted to participate in the Activity or Trip, I hereby accept all risk to Participant s health and of his/her injury or death that may result from such participation and I hereby release Missouri Western State University, its governing board, officers, employees and representatives from any and all liability to Participant, Participant s personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to Participant s property and for any and all illness or injury to Participant s person, including his/her death, that may result from or occur during Participant s participation in the Activity or Trip, whether caused by negligence of Missouri Western State University, its governing board, officers, employees, or representatives, or otherwise. I further agree to indemnify and hold harmless Missouri Western State University and its governing board, officers, employees, and representatives from liability for the injury or death of any person(s) and damage to property that may result from Participant s negligent or intentional act or omission while participating in the described Activity or Trip. I have carefully read this agreement and understand it to be a release of all claims and causes of action for participant s injury or death or damage to participant s property that occurs while participating in the described activity or trip and it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by participant s negligent or intentional act or omission. Signature of Parent/Guardian Date Signature of Witness Date Printed Name of Parent/Guardian Printed Name of Witness Address (if different from Participant s address)

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