Rev 032019
Applicant's Name:
Applicant's Banner ID Number:
Applicant's Signature of Agreement to T
erms:
Name of Supervisor:
Supervisor's Signature of App
roval of Request:
Briefly explain how the applicant meets the requirements of the College policy:
Budget Source for Applicant's Request: Fund Org
Amount of Monthly Allowance:
Approvals:
Budget Head Approval of Funding:
Finance Approval of Funding:
Cabinet Member's Approval:
Chancellor's Approval:
Send form to Human Resources for processing after funding approval.
Application for College Cellular Phone Utilization and Reimbursement
The applicant agrees to adhere to the College and LCTCS policies regarding Cellular Phone Utilization and
Reimbursement and has met the qualifications per said policy to receive this allowance/usage.
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