Idaho State University
Permanent Change Fund Request Form
FS-001
Requesting Department:
Increase to Existing Fund Amount of Increase $
Create New Fund Amount Requested $
Justification for Fund or Fund Increase:
Estimated Monthly Revenue:
Security for Fund Use and Storage:
Fund Custodian
Phone Location
I understand that the need for and the amount of this fund will be reviewed at least annually; that confirmation of the fund balance will
be made at least annually (at fiscal year-end); and that I am to notify the Office of Finance and Administration of any changes in the
above information. I further declare that I have read and understand the petty cash fund procedures in the Faculty/Staff Handbook and
understand I am personally responsible for this fund and for ensuring it is properly accounted for and maintained.
Fund Custodian Date
Department Chair, Dean, or Director Date
Please submit this form to Finance and Administration, Stop 8219
For Finance and Administration Only:
Assistant Controller Date
Change Fund Code:180015 10401
UBO Date
