Encumbrance Removal Form - Purdue University Office of the Dean of Students

Complete the information below and submit after the student has paid their encumbrance to the organization.
Name of Group Requesting Encumbrance Removal
Student's FULL Name
Student's Complete Address
Student's PUID#
Amount Requested for Encumbrance Removal ($)
President's Printed Name
President's Phone Number
Treasurer's Printed Name
Treasurer's Phone Number
Person Submitting Form
Person Submitting Form Phone Number
Person Submitting Form Position