Fillable Application For Selfsupport Program

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Application For Selfsupport Program

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SELF SUPPORT PROGRAM/ACTIVITY APPLICATION
SEND ORIGINAL FORM WITH ORIGINAL SIGNATURES TO: AL LAGOS, FINANCIAL SYSTEMS
Program Name/ Title: _______________________________________ Today’s Date: __________
Name of Requestor: _______________________________________ Phone Extension: __________
Department: _______________________________________
Email Address: _______________________________________
Contact Person for Budget Issues: _______________________________________ Phone Extension: __________
Who should have report access: ____________________________________________________________________
Mission/Purpose of the Program (Attach any applicable brochure):
Who is
your
customer base? ________________________________
Will this program be permanent? Yes No
If not, indicate estimated time period _____________________________________________________
Individual Responsible for the Program: ________________________________
Department and Division: ___________________________________________
BUSINESS/ FINANCIAL PLAN INFORMATION:
Revenue/Fund Source
Indicate all sources of revenue:
How will revenue be collected? Cash Checks Credit Cards
Will you be billing? Yes No
Should a new FUND be created for this program? Yes No
Should this program use existing FUND? FUND#:___________
Expenses
Indicate anticipated general expenses:
Payroll
Will the department have payroll? Yes No
Regular Contractual Student Help
Separation of Duties
Indicate the name and position of the staff that will be responsible for
Billing:
______________________________________
Collecting, preparing & depositing revenue: ______________________________________
Reconciling/ monitoring the account:
Department Number Issued: _____________ Issued By: ___________________ Date: _________
Fund: ________
Hiring Department: _______________
Division: _______________________ Subdivision: _______________________ School: _________
Program: ________ Subprogram: ________
FOR OFFICE USE
CLEAR ALL FIELDS
REQUIRED
REQUIRED
REQUIRED
TOWSON UNIVERSITY BUSINESS PLAN
SELF SUPPORT PROGRAM / ACTIVITY OR AGENCY APPLICATIONS
ACCOUNT REQUESTED
BUDGET LOAD
REVENUE
Account Name:
Account number:
Account Name:
Account number:
Account Name:
Account number:
Transfers IN
499908
Transfers OUT
499908
1% Fund Balance Contribution
499918
NET REVENUE
EXPENSES
Object 01 Salaries & Benefits
Ex.: Regular Overtime 501605
Account Name:
Account number:
Account Name:
Account number:
Account Name:
Account number:
Account Name:
Account number:
Ob
ject 02 Contingent Salary & Fringe
Ex.: Student Help 502601
Account Name:
Account number:
Account Name:
Account number:
Account Name:
Account number:
Account Name:
Account number:
Account Name:
Account number:
Account Name:
Account number:
Ob
ject 03 Communications
Ex.: Postage 603003
Account Name:
Account number:
Account Name:
Account number:
Account Name:
Account number:
Object 04-14 Operating
Ex.: Housekeeping 608106
Account Name:
Account number:
Account Name:
Account number:
Account Name:
Account number:
Account Name:
Account number:
Account Name:
Account number:
Account Name:
Account number:
Account Name:
Account number:
Account Name:
Account number:
6.5% IDC Charge
699999
TOTAL EXPENSES
Budgeted Profit/(Loss)
Acknowledgement and Approval Information:
By
completing and signing this self-support program/activity application, we understand that there is a need to strive to serve and enrich the TU campus and surrounding
communities and to become financially self-sufficient. Self Support programs/activities are expected to be self-funding and to generate sufficient revenue to pay all expenses.
Programs and/or activities are expected to have a net surplus at the end of the fiscal period. In the event of a revenue shortfall, it is understood that the sponsoring department,
college and/or division will be responsible for supplementing program revenue to cover outstanding expenses. Programs/activities not meeting financial expectations are subject to
review and possible termination at the discretion of the Divisional Budget Officer.
Thi
s application must be reviewed, discussed and approved by your Department Head/Chair, Dean and your Divisional Budget Officer prior to submitting to the University Budget
Office.
Signature of Requestor:
Approval and Signature of Department Head/Chair:
Approval and Signature of Dean:
Approval and Signature of Divisional Budget Officer:
Approval and Signature of University Budget Office:
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Application For Selfsupport Program

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Completed 3 November 2019

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