School Name______________________________
Date ____________________________________
STUDENT ACTIVITIES TRAVEL REQUISITION
Mesa Unified Schools
REQ # __________________________ Buyer # _______________
Student Activities secretary will fill in #
Account/Club Name _____________________________ Acct. No.____________________________________
______________________________________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________
REQUEST FOR A CHECK OR CASH ENVELOPE
This section should be used to request the following:
1. Cash Envelopes 2. Payments to another Mesa District school
 Please draw a check or cash envelope to:
Amount $ ___________________
Vendor # ______________________
Send Check To:
Student Activities secretary will fill in #
Vendor Name ______________________________________
 Vendor
Address ___________________________________________
 Requisitioner
__________________________________________________
 Other
Purpose: (Include Event, Dates, etc.) __________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________
REQUEST FOR A PURCHASE ORDER
P.O. # ____________________
Student Activities secretary will fill in #
 Issue purchase order to:
Vendor # _________________________
Amount $ ___________________
_
Vendor Name ______________________________________
Address ___________________________________________
__________________________________________________
Phone ____________________________________________
Send P O To:
 Vendor
 Requisitioner
 Other
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TRIP DESCRIPTION
Number of students ______ Number of teachers ______ Number of all other adults ______
Date of trip: From ______________ to ______________ Destination _______________________
Check all funds to be used: ECA _______ Student funds ________
SIAC minutes date (only if using ECA account #8002 funds) ____________
A copy of the itinerary needs to be mailed or faxed to Student Activities if any ECA funds are used for out of state
travel.
Total expected cost of trip: ____________
Date of Superintendent’s approval if overnight or out of state: ___________ (not required if AIA athletic event)
Purpose of trip ____________________________________________________________________________
________________________________________________________________________________________
Additional Information _____________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
AUTHORIZING SIGNATURES
Student Club Officer ________________________________________
Student Council Officer ______________________________
Club Sponsor/Advisor ___________________________ Ext. ________
Student Council Advisor _____________________________
_____ As Sponsor/Advisor, I acknowledge that no merchandise or
services have been received. If this is an after the fact purchase, I
acknowledge that I may be personally responsible for all costs.
Student Council Meeting Minutes Date _________________
Principal __________________________________________
_____________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________
DISTRICT USE ONLY:
District Student Activities Approval _______________________ C/E Date ___________ Ck # _____________
Approval Date __________________
C/E Date Due __________________