Department Deposit Form

Form Information

Required fields are marked by an asterisk.

Leave Submit Date and Reference Number as default values unless otherwise instructed.

Form Submit Date This question requires a valid date format of MM/DD/YYYY.

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Form Reference Number

Dates

Provide the date the payment(s) were received, as well as the start and end dates of the service period covered by the payment(s).

*This question is required.

If the period covered by the payment is one day, then enter the same date in both start and end fields.

Received Date This question requires a valid date format of MM/DD/YYYY.

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Earliest Start Date This question requires a valid date format of MM/DD/YYYY.

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Latest End Date This question requires a valid date format of MM/DD/YYYY.

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Department Information & Purpose

Provide your name as the preparer of the form, the requested information for your department, and a short statement of purpose about the funds received.

Prepared By *This question is required.

Department Name *This question is required.

Department Address *This question is required.

Mail Code *This question is required.

Phone Number *This question is required. This question requires a valid number format.

Email *This question is required. This question requires a valid email address.

Provide a brief description which summarizes the purpose of the funds. *This question is required.

Cash Denomination Totals

Paper Currency

Space Cell	Quantity of Bills	Calculated Sum
$100	$100: Quantity of Bills	$100: Calculated Sum
$50	$50: Quantity of Bills	$50: Calculated Sum
$20	$20: Quantity of Bills	$20: Calculated Sum
$10	$10: Quantity of Bills	$10: Calculated Sum
$5	$5: Quantity of Bills	$5: Calculated Sum
$2	$2: Quantity of Bills	$2: Calculated Sum
$1	$1: Quantity of Bills	$1: Calculated Sum

Coins

Space Cell	Quantity of Coins	Calculated Sum
$1.00	$1.00: Quantity of Coins	$1.00: Calculated Sum
$0.50	$0.50: Quantity of Coins	$0.50: Calculated Sum
$0.25	$0.25: Quantity of Coins	$0.25: Calculated Sum
$0.10	$0.10: Quantity of Coins	$0.10: Calculated Sum
$0.05	$0.05: Quantity of Coins	$0.05: Calculated Sum
$0.01	$0.01: Quantity of Coins	$0.01: Calculated Sum

Calculated Cash Total This question requires a valid currency format.

Check Totals

Check Information

Verify each check is endorsed

Space Cell	Check Description	Check Number	Amount
Check 1	Check 1: Check Description	Check 1: Check Number	Check 1: Amount
Check 2	Check 2: Check Description	Check 2: Check Number	Check 2: Amount
Check 3	Check 3: Check Description	Check 3: Check Number	Check 3: Amount
Check 4	Check 4: Check Description	Check 4: Check Number	Check 4: Amount
Check 5	Check 5: Check Description	Check 5: Check Number	Check 5: Amount

Calculated Check Total This question requires a valid currency format.

CFOAPAL Information

The total amount you enter in the CFOAPAL fields below must match the required total shown below.

Chart This question requires a valid number format.

Fund This question requires a valid number format.

Organization This question requires a valid number format.

Account This question requires a valid number format.

Program This question requires a valid number format.

Activity

Location This question requires a valid number format.

Description

Amount This question requires a valid currency format.

Department Deposit Form

Form Information

University Location

Dates

Department Information & Purpose

Cash Denomination Totals

Paper Currency

Quantity of Bills

Calculated Sum

Coins

Quantity of Coins

Calculated Sum

Check Totals

Check Information

Check Description

Check Number

Amount

CFOAPAL Information

Attestation