Theatre Student Account Disbursement Form
Email address *
Student's Name
Your answer
Date Disbursement Requested
MM
/
DD
/
YYYY
I am requesting that money from my student theatre account in CHARMS cover the following expense:
What amount would you like transferred to cover this expense?
Your answer
If a miscellaneous expense was noted above, please describe the purpose of this disbursement.
Your answer
I give permission for the theatre department to use money credited to my CHARMS account to cover the requested expense.
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