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

Required

I agree that all of this information is accurate and I am an authorized agent of this organization