REQUEST FOR CELL PHONE ALLOWANCE
Form is to be completed prior to the beginning of each fiscal year (July 1 June 30).
EMPLOYEE INFORMATION
NAME: EMPLOYEE ID#:
DEPARTMENT:
DESCRIPTION OF BUSINESS NEED
CELL PHONE TIER LEVEL REQUEST (Monthly): Level 1 - $30 Level 2 - $50 Level 3 - $75
Budget Number:
V
ERIZON MiFi WIRELESS DEVICE ($40.01 per month = $480.12 per year):
Other type of communication device: Amount:
Budget Number:
E
mployee must provide a detailed explanation as to why he/she is making the request.
SIGNATURE
By signing this document, I acknowledge that I have reviewed the Allowance for Cellular Phone or Other Mobile
Communications Devices Policy (4.39.1). I acknowledge that this request may be denied. If approved for cell phone
allowance reimbursement, I verify that I will sign up through eCentral for my allowances to be direct deposited monthly
into my personal account. If my request is for other mobile communication devices, I acknowledge that the other mobile
communication device will be deducted from the specified budget number listed on this form on a monthly basis.
E
mployee: Date:
APPROVAL SIGNATURES
S
upervisor: Date: Approve: Yes
No
V
ice President: Date: Approve: Yes
No
C
ollege President: Date: Approve: Yes
No
F
inancial Services Director: Date: Funds Available: Yes
No
ADDITIONAL COMMENTS
Rev. 10/12/17
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