Responsible Department:  ____________________________________________________________

Date of Proposed Event:  ____________________________________________________________

Proposed Location of Event:  _________________________________________________________

Number of Guests Expected:  ___________________

Names and Affiliations of Attendees (if more than ten, identify group; use back if necessary):

__________________________________________________________________________________________

__________________________________________________________________________________________

Purpose of Event and Benefit(s) to UTHSC-H: __________________________________________________________________________________________

__________________________________________________________________________________________

Category	Category Costs Estimated	Costs per Person Estimated	Category Costs Actual	Cost per Person Actual
Food	$________	$________	$________	$________
Beverages	$________	$________	$________	$________
Music	$________	$________	$________	$________
Other	$________	$________	$________	$________
Total Costs	$________	$________	$________	$________

Submitted by: ___________________________________    Date: __________

Recommended Approval

Department Chair: ____________________________________   Date: __________

Dean/Vice President: _______________________________________   Date: __________

Approval

Chief Financial Officer or designee: __________________________________   By: __________

The Chief Financial Officer or designee will return all APPROVAL FORMS to the designated Dean or Vice President as an acknowledgement of the Chief Financial Officer's or designee's decision. Copies of the approved and updated APPROVAL FORM must be submitted to the Office of Accounting with any subsequent Requests for Issuance of Check referencing this event.