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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 - 5pm.

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

Questions? 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 FSA team.

Quick links:


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

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 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

For all FSA paid Employees:

FSA Employee Handbook

FSA Biweekly Time Sheet (blank)

FSA Job Applicants:

FSA Employment Application Form

FSA Background Check Consent 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: Submit your Payment Request Form and add this prominent note in purpose/description section: "Mail a Tax Exempt Certificate to Vendor with Check". These forms are NOT available for download. Both FSA and HSCBF are NYS sales tax exempt organizations. However, FSA and HSCBF handle many different types of accounts for many campus organizations, some of which may NOT be NYS sales tax exempt, and therefore requests for a sales tax exempt certificate must first be reviewed for appropriateness. Instruct your vendor that they will receive the tax exempt form in the mail with the check payment; 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 (see INFO box at top left of this page) with the vendor's direct contact information. The FSA Business Office will contact the contact the vendor directly to provide it. Misuse of a NY 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: Most common problem is a mailing delay - allow 10 business days before determining the check is 'lost' unless it's a significant urgent circumstance. The longer wait time avoids a 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 uncashed check with a new payment form with the corrected details to the FSA Business Office. 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: pdf format eForms - Always return to this page when initiating a new blank form to ensure using the most current updated form.

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 - if ordering items that are not on the standard menu,  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 scan signed form & eMail to Cafe 101; or fax to 718-270-4661. Send the original signed hard copy via interoffice mail to Cafe 101 at MailStop 1214. For imminent needs,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* Only for catering paid by Student Councils. Requires MS Excel.

Submit 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 Cafe101to discuss/ confirm availability and the agreed pricing for added items. Instructions:

1. Download, complete, then print & sign the form. Insert the qty and add additional items not on the standard menu. 'Save the completed form, then print it for signature and processing.

2. Submit- You can either:

  • Hand deliver: the original hard copy to Student Center Rm 2-06 (this is the best method if your event is imminent), or
  • 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 MailStop 114.

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

SAF Most Frequently Used Forms:

Payment Request Form ( FSA001).       Form Instructions for SAF Account Holders

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



UC Constitution proposed 2017 and UC Club Budget Funding Guidelines

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.

CLUBS and ORGANIZATIONS: Questions? Student Activities Office - Amy Urqhuart (eMail link).

SAF Clubs & Organizations with Current Officers - Shows all current registered student clubs and  organizations with current officers. In order to receive SAF funding, a current approved registration is required (Registration form is below). Submit officer updates as they occur.

Student Council Summary Descriptions

Student Clubs and Organizations Summary Descriptions

TRAINING: Student Leadership Training Presentation (Fall 2017)

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

Club & Org Funding Request Form. To request funding from a Student Council.

Club & Org Monthly Activity Report Form: To report your club's monthly activities to the Student Activities Office

Club & Org Service Learning Form: All funded Student Clubs and Organizations must complete a minimum of TWO service learning  projects. Use this form to report your service learning project plans.

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.

Room Reservation Form. To request and reserve use ANY DMC facility/ space. Complete and submit to Student Activities Office (eMail link) who coordinates all student clubs & orgs reservations.



2018 "Current Year"SAF Council 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-SNS,  MSC-YBK,   MSC Budget Funding Guidelines

University Student Council documents: UC, UC Club Budget Funding Guidelines


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

SAF Report Instructions (link) Reports include a cover summary report comparing current year certified budget to year to date actual amounts, followed by a detail transaction report of each subaccount.

Understanding SAF Account Detail Transaction Report (link)

Questions on your report and reporting potential discrepancies: Please Use the FSA Business Office Team eMail link in the INFO box (upper right of all FSA pages).


2018 SAF Council 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.


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 All DMC Student Council meeting minutes.

eMail link to submit final signed SAF Council meeting minutes.

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

FSA Payment Form (FSA001)

Understanding your FSA Account Transaction Report:

New TA Report Format; FSA TA reports issued October 31, 2107 and after

Old TA Report Format; FSA TA reports issued September 30, 2017 and prior (in case you are viewing an older FSA TA report)

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.

Inquiries: Please Use the FSA Business Office Team eMail link in the INFO box (upper right of all FSA pages)


FSA Board of Directors Forms/ Documents:

FSA Board of Directors meets quarterly; Board approved 2018 meeting dates are Wed 1/17/18, 4/18/18, 7/18/18 and 10/17/18; All at Noon in Student Center; Most recent agenda's and minutes posted here.

FSA BOD Agenda 1/17/18

FSA BOD Draft Minutes 10/27/17 Members present are asked to review and submit any proposed revisions. Note: Draft minutes are not official until accepted at following meeting. Auditors Presentation to BoardCPA Report 5/31/17

Vending Presentation 1/17/18

Operations Report 1/17/18

Bookstore Report 1/17/18

BOD Meeting Proxy Form. Used by FSA voting Board members when you are unable to attend an FSA Board of Directors meeting. Email to Meg O'Sullivan or Fax to 718-270-1040

FSA BOD Handbook: includes FSA structure, governance, Board member responsibilities, and pertinent corporate documents: Bylaws, Organizational Chart, Members, Annual Budget (draft), and prior year CPA report (CPA issued no recommendations to Management)

FSA Employee Handbook. For all FSA paid Employees.

FSA Presentation to Campus President's Transition Team (2017; summary - key points)


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

FSA Procurements - Requests for Proposals:

Laundry Services RFP August 2017