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FSA Forms & Documents

FSA Business Office INFO

Phone: 718-270-3187
Fax: 718-270-3845
MailStop: 1219
Location: STUDENT CENTER, 394 Lenox Rd, Rm 2-09

Mon - Fri (Except Holidays) 8am - 4pm.

Controller: FSA Business Office Team eMail, 718-270-3148

* pdf format forms: Return to this page when initiating a new blank form to ensure having the most current updated form. Forms can be downloaded to your hard drive, then completed and saved to your hard drive with a unique document name, but do confirm your saved form remains current. Print the completed form for signature and processing.

Quick links:

Business Office Staffing Update

  • Rodney Venten retired as Director of Finance on 1/8/16. FSA thanks Rodney for his dedicated services and wishes him a prosperous and healthy future. The Director of Finance is being transitioned to the new role of "Controller" being provided by the firm of Demasco Sena and Jahelka, LLP (DSJ) until a permanent Controller is engaged. The DSJ partners serving include Christopher Sena, Bob Jahelka, and Anthony Carrella - Use the eMail link in the INFO box to contact the FSA Business Office team.
  • Matthew Jarvis of DSJ is temporarily filling the Bookkeeper role.

Business Office Payment Forms*:

The FSA Business Office processes all payments for accounts of BOTH the Faculty Student Association (FSA) as well as Health Science Center at Brooklyn Foundation (HSCBF). Please select the proper payment form (below) for your account. Print, sign, then send to FSA Business Office MailStop 1219,or Hand Delivered to Student Center Rm 2-09. An advance eMail attachment or fax of the completed form to Ext 3845 will be accepted only to expedite a transaction/ check processing; the original signed form is still required prior to a payment being released:

FSA001 Payment Request Form (pdf eForm). For all FSA accounts including FSA, T&A, and SAF accounts.

Form FSA001 General Instructions.        

Form FSA001 Instructions for SAF Accounts.

FSA IRS Independent Contractor Common Law Test Questionnaire

W-9 IRS Taxpayers ID and Certification Form

HSCBF002 Payment Request & Voucher Form (Excel format). Requires MS Excel. HSCBF002 Processing Instructions (pdf). For all Health Science Center at Brooklyn Foundation Inc. (HSCBF) Accounts.

More HSCBF documents are posted on Finance Website - HSCBF (link)

FSA or HSCBF Sales Tax Exempt Certificate: These forms are NOT available for download. FSA and HSCBF are NYS sales tax exempt organizations. For out-of-NYS purchases, some other states do honor NYS sales tax exempt organization's status, while other states do not accept it. In addition, since FSA and HSCBF handle many different types of accounts for many campus organizations, some of which are NOT NYS sales tax exempt, requests for the sales tax exempt certificate must first be reviewed for appropriateness. To request an FSA or HSCBF sales tax exempt certificate, or discuss whether your purchase from your account meets eligibility requirements, please eMail the FSA Business Office Team. Read the Instructions on the use of form ST-119.1 Misuse of a NYS sales tax exempt certificate for inappropriate purchases is a violation and subjects the purchaser to civil and criminal sanctions in addition to payment of tax and interest due.

Cafe 101 Catering Forms*:

The standard Cafe 101 Catering Form is used by ALL campus departments and entities; the Student Activity Fee (SAF) Catering Form is exclusively used only by Student Council funded groups/ clubs.

Cafe 101 Catering Form* use for all DMC department & affiliate funded catering. Instructions:

1. Download, complete the form - it allows you to insert the qty and add additional items that are not on the standard menu, BUT you must speak in advance with Cafe 101 to discuss and confirm availability and the agreed pricing for any such added items.

2. If your event is imminent, to prevent any order acceptance delay, always call Cafe101 in addition to faxing or e-mailing your catering form.

3. Print, sign, then either

  • scan signed form & eMail to Cafe 101,fax to 718-270-4661
  • then send the original hard copy via interoffice mail to Cafe 101 at MailStop 1214, or for imminent needs, it's best to Hand Deliver to Student Center Rm 2-20.

STATE Account funded catering: Once you have an agreed upon menu and quotes, process your requisition to State Procurement (purchasing) Office. Cafe 101 can not finalize your catering request until Cafe 101 receives a valid State PO number from the State Procurement Office. Depts with ongoing catering needs are urged to plan and fund your State purchase requisition for your estimated annual catering needs.

Cafe 101 Student Activity Fee (SAF) funded Catering Form* Requires MS Excel; For Student Activity Fee (SAF) funded catering only ie: paid by Student Councils.

Submit your completed catering form 1 week in advance of the event. A Catering Tray typically serves 15 to 20 people. Be sure you have spoken in advance with Cafe 101 at Ext 2449 (718-270-2449, or cell at 347-683-3383 ) to discuss and confirm availability and the agreed pricing for any added items. Instructions:

1. Download, complete, then print & sign the form. The form allows you to insert the qty and add additional items not on the standard menu. You can 'save as' the form as you have typed it onto your hard drive so that you can then print it off for signature and processing.

2. Submit- You can either:

  • Scan/eMail: scan the signed SAF Catering Form and eMail to Student Center Director (link), then send the original hard copy via interoffice mail to Student Center Director at MailStop 114, or
  • Fax: to 718-270-1040, then send the original hard copy via interoffice mail to Student Center Director at MailStop 114, or
  • Hand deliver: the original hard copy to Student Center Rm 2-06 (this is the best method if your event is imminent)

3. The Student Center Director will approve the form, obtain the Council Treasurer's signature (if needed), and submit the final order form directly to Cafe 101.

4. Upon delivery at the catered event, the Cafe 101 delivery staff will have a copy of your catering form. The event coordinator or their designee at the event then signs the final section "Acceptance of Satisfactory Completion".

No FSA payment form is needed when you follow this process. Cafe 101 submits to FSA an invoice and the completed catering form, then payment is processed from the designated SAF account.

Questions: Call the Student Center Main Office Ext 2484 (718-270-2484) or the Director Ext 2485 (718-270-2485) for more information.


Student Activity Fee (SAF) Related Documents for DMC's Student Councils and Clubs:

Student Leadership Training Presentation (Fall 2015)

SAF Clubs-Organization Leadership (officers) - please send updates as they occur to Amy Urqhuart (eMail link).

FSA Payment Request Form (pdf eForm) *. For all FSA accounts including FSA, SAF, and T&A accounts. The Cafe 101 SAF Catering Order form is found in the preceding section above.

FSA001 Form Instructions for SAF Accounts.

Constitutions/ Bylaws: Councils that desire changes/ amendments to their certified constitutions are urged to review the desired changes with FSA in advance of presenting them for a Council vote. This better assures the amendments will be subsequently accepted on behalf of the campus. CHRP., GSSC, . MSC., NSC.RHC.,  SPH.SCGB.UC.


SUNY Summary Raffles on SUNY Campuses.

SAF Meeting Minutes Guidelines. Used by all Student Activity Fee (SAF) Organizations such as Student Councils and Clubs to document all meetings.

SAF Meeting Attendance Form/ Template. Can be used by any SAF student organization and attached to meeting minutes.


SAF Financial Documents:

2015/16 "Current Year" Certified Budgets: (click on Council acronym to view the document for that council): CHRPGSSCMSC,   MSC Budget Funding Guidelines,   MSC-SNSNSC,  RHCSPH,  SCGBUC

Fiscal Year to Date (YTD) Actual Reports: click on Council acronym to view the document for that council: CHRP,   GSSC,   MSCMSC-SNS1MSC-SNS2,   NSC,   RHCSPHSCGBUC

General Instructions (link) Posted statements show all deposits as well as all reconciled disbursements/ transfer transactions: "Reconciled" means verified against the actual bank account statements from banks. Bank statements are received within a week of each month end, which FSA then reconciles against the transactions that have been entered into the accounting system, making any needed adjusting transactions. Once posted in all accounts, the accounting system month can be ended - called "closed" and all reports can then be generated. This provides an inherent delay of about 1 month in making statements available to account holders. Council Treasurers and Club Officers (Account Holders), can always contact the FSA Business Office to receive a current raw transaction report or estimated balance.

Understanding SAF Transaction Reports (link)

Questions on your report and reporting potential discrepancies: eMail the FSA Business Office Team.

SAF Budget Planning Documents for Next (future) Fiscal Year:

SAF Accounts- FSA Policies and Procedures

SAF Current Rates for all DMC Student Councils

SAF SUNY Board of Trustee Guidelines.

SAF Account Authorized Signature Change Form used when officers/ authorized signators change during the year.



Trust and Agency (TA) Account Related Forms and Documents:

Understanding your TA Account Transaction Report (sample)

TA Account Application Form*. Used to apply for a New T&A Account. Print, sign, then send to FSA Business Office Box 1219, fax 718-270-3187

TA Account Revision Form*. Used to update an existing TA Account's purpose, types of expenses, authorized signator changes. Print, sign, then send to FSA Business Office Box 1219, fax 718-270-3187

TA Account for Temporary Party Fund*. To be used for collection of voluntary contributions for a specific one time event or purpose (retirement parties, holiday parties, staff personal event celebrations, one time charitable purpose, etc..).

TA Account FSA Policies and Procedures*. The current FSA policies and procedures that govern all SAF and TA accounts.

SUNY Guidelines on Trust and Agency Accounts.


FSA Board of Directors Forms/ Documents:

FSA BOD Handbook*: Summarizes FSA structure, governance, Board member responsibilities, and pertinent corporate documents including Bylaws, Organizational Chart, and Annual Budget and prior year CPA report and its Management recommendations and response.

FSA BOD Agenda 4/20/16.

FSA BOD Draft Meeting Minutes 1/20/16 Note: Draft minutes are not official until accepted at following meeting. Members present are asked to review and submit any proposed revisions

FSA Board of Directors Meeting - Proxy Form*. Used by FSA voting Board members when you are unable to attend an FSA Board of Directors meeting. Fax to 718-270-1040

FSA Employee Handbook*. For all FSA paid Employees.


FSA003- Mobile Vending Permit Application Form.             Procedure for Obtaining a Mobile Vending Permit

FSA Procurements - Requests for Proposals

Catering and Food-Beverage Cart Services RFP dated March 31, 2014 (link).