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FSA Forms & Documents

FSA Business Office INFO

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

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

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

*pdf format eForms: Always return to this page when initiating a new blank form to ensure using the most current updated form.

Business Office Staffing Update

  • Tailin Brecher, FSA Treasurer resigned from DMC service 6/2/17; role is pending new appointment and election.
  • The role of "Controller" is being filled by the firm of Demasco Sena and Jahelka, LLP (DSJ) until a permanent Controller is engaged. The DSJ staff includes Christopher Sena, Bob Jahelka, Anthony Condoleo, and Anthony Carrella.
  • Deshawn Hilliard joined the FSA Business Office staff in the role of Bookkeeper (Sept 2016).
  • Please Use the FSA Business Office Team eMail link in the INFO box (upper right of all FSA pages); It will auto-address an eMail to all relevant individuals on the team.

Quick links:


Business Office 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*. 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

I-9 Used when payee is an employee relationship

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. Both FSA and HSCBF are NYS sales tax exempt organizations but 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 a sales tax exempt certificate must first be reviewed for appropriateness. Vendors requiring the form should be instructed that they will receive the tax exempt form they will receive in the mail with the check payment. Submit your Payment Request Form and add this prominent note: "Mail a Tax Exempt Certificate to Vendor with Check". The FSA Business Office will complete a tax exempt form for that vendor and mail it with the check payment directly to the vendor. If a vendor requires the certificate in advance, please eMail the FSA Business Office Team with the vendor's direct contact information. The FSA Business Office will contact the contact the vendor directly to provide it. 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. For out-of-NYS purchases, some other states do honor NYS sales tax exempt organization's status, while other states do not accept it. NYS Instructions on the use of form ST-119.1

Replacement checks: for either a lost check, error correction, or a stale dated check. The account holder must notify the FSA Business Office via eMail with all relevant details (use the Business Office team eMail link in the INFO box upper right corner of this page).

  • If the original check is NOT available: The most common problem is a mailing delay - recommend allowing sufficient time up to 10 business days before determining the check is 'lost'. Unless there is some significant urgent circumstance, the longer wait time avoids the common occurrence that by the time the new check is received, the original check is already received/ deposited which then incurs a double Bank Fee (the payee's bank fee plus the bank fee to the FSA account). FSA will verify with the Bank whether the check has been cashed. If it has not, a bank Stop Payment can be processed for check amounts over $30. The bank fee is near $30 and will be charged to your account. A copy of the initial payment form will be used to re-issue a new check.
  • If the original check is available: a bank stop payment is not necessary. Deliver the original check with a new payment form with the corrected details to the FSA Business Office, or if NO corrections are needed, a copy of the initial payment form can be used to re-issue a new check.

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 to avoid the need for individual event PO's.

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:

SAF Most Frequently Used Forms:

Payment Request Form ( FSA001).       Form Instructions

Cafe 101 SAF Catering Order form .  To order catering services for your club's events. Using this form eliminates the need for a separate FSA Payment Form

Student Center Soda and Supply Order Form. To order soda and common event supplies for Club events. Using this form eliminates the need for a separate FSA Payment Form

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



Councils considering 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 certified on behalf of the campus.


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.

Current Year Student Council Meeting Minutes

CLUBS and ORGANIZATIONS: Questions? Amy Urqhuart (eMail link).

SAF Clubs & Organizations - Shows all current campus sanctioned (registered with Student Activities) student clubs and  organizations with current officers. In order to receive SAF funding, a current approved registration is required (Registration form is below). Please send updates as they occur.

Club & Org Registration Form. Clubs and Organizations must REGISTER EVERY academic year to be sanctioned by the campus. Must update registration as changes occur.Amy Urqhuart (eMail link).

Soda and Supply Order Form. To order soda and common event supplies for Club events. Using this form eliminates the need for a separate FSA Payment Form. Amy Urqhuart (eMail link).

Room Reservation Form. To request and reserve use ANY DMC facility/ space, complete this form and submit to Student Center Director who coordinates all student clubs & orgs reservations. Amy Urqhuart (eMail link).

TRAINING: Annual Club and Org Student Leadership Training Presentation (Fall 2017)



2018 "Current Year" Certified Budgets: (click on Council acronym to view the document for that council): CHRP,   GSSC,    NSC,   RHC,   SCGB,   SPH.

Medical Student Council documents: MSC MSC-SNSMSC-YBK,   MSC Budget Funding Guidelines

University Student Council documents: UC, UC Budget Funding Guidelines

Fiscal Year to Date (YTD) Actual Reports: click on desired Council acronym: CHRP,   GSSC,   MSCMSC-SNS1MSC-SNS2MSC-YBKNSC,   RHC,   SCGBSPH UC

SAF Report Instructions (link) Posted statements show all reconciled 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 "closing the month" 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 with its current balance (not yet fully reconciled).

Understanding FSA Account Transaction Report (link)

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


2018 SAF Budget Planning RESOURCES and TOOLS: Used by Student Councils to submit their annual student activity fee budget, or to submit revised budgets during the year. Budgets are due in May of each year.

Other SAF Resources and Documents:

FSA Policies and Procedures for SAF Accounts

SAF SUNY Board of Trustee Guidelines.

SUNY Summary Raffles on SUNY Campuses.




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

FSA Payment Form (FSA001)

Understanding your FSA 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 Application for Temporary Party Fund. 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 Board of Directors meets quarterly; Board approved 2017 meeting dates are Wed 1/18/17,  Thurs 4/20/17, Wed 7/12/17, and Wed 10/18/17, All at Noon in Student Center; Most recent agenda's and minutes posted here.

FSA BOD Draft Minutes 7/12/17 Note: Draft minutes are not official until accepted at following meeting. Members present are asked to review and submit any proposed revisions.

FSA BOD Agenda 7/12/17

FSA BOD Minutes 4/20/17

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

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.

FSA Presentation (summary - key points)


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

FSA Procurements - Requests for Proposals