"Request Form to Authorize Moving and Relocation Expenses"

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FORM#11
REQUEST TO AUTHORIZE MOVING AND RELOCATION EXPENSES
Approval is requested to authorize reimbursement for moving and relocation expenses as noted below.
I. IDENTIFICATION DATA:
Name of Faculty Member: ________________________________________________________
Academic Rank/Title: ___________________________________________________________
Position Number: _______________________________________________________________
Effective Date of Employment: ____________________________________________________
Relocation From (City, State): _____________________________________________________
II. JUSTIFICATION FOR NON-ROUTINE REQUESTS:
III. RELOCATION FUNDS REQUESTED:
A. University Recruitment Budget
Total Amount requested from University Recruitment Budget: $
B. Department Budget
Amount to be provided from department/college funds: $
Specify budget to be charged:
C. Total amount designated for moving/relocation expenses: $
Updated 06/2011
FORM#11
REQUEST TO AUTHORIZE MOVING AND RELOCATION EXPENSES
Approval is requested to authorize reimbursement for moving and relocation expenses as noted below.
I. IDENTIFICATION DATA:
Name of Faculty Member: ________________________________________________________
Academic Rank/Title: ___________________________________________________________
Position Number: _______________________________________________________________
Effective Date of Employment: ____________________________________________________
Relocation From (City, State): _____________________________________________________
II. JUSTIFICATION FOR NON-ROUTINE REQUESTS:
III. RELOCATION FUNDS REQUESTED:
A. University Recruitment Budget
Total Amount requested from University Recruitment Budget: $
B. Department Budget
Amount to be provided from department/college funds: $
Specify budget to be charged:
C. Total amount designated for moving/relocation expenses: $
Updated 06/2011
IV. AUTHORIZATION:
The amount shown above is requested from the University Recruitment Budget as a reimbursement
for the above named individual in accordance with the policies and procedures governing Moving
and Relocation Expenses.
______ Recommend Approval
_______________________ _______
______ Recommend Denial
Dean/Director
Date
______ Recommend Approval
_______________________ _______
______ Recommend Denial
Academic Services Analyst
Date
______ Recommend Approval
________________________
_______
______ Recommend Denial
Vice President
Date
V.
PROVOST'S ACTION:
_______ Approved as requested.
_______ Disapproved as requested. Total funds authorized from the University Recruitment
Budget: $____________________________. Specific allocation is amended as noted above.
_______________________________________
___________________
Provost and Vice President for Academic Affairs
Date
Updated 06/2011
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