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: BUDGET NUMBER:
DESCRIPTION OF BUSINESS NEED
TIER LEVEL REQUEST: Level 1 - $30 Level 2 - $50 Level 3 - $75
Employee must provide a detailed explanation as to why he/she is making the request.
TIME PERIOD OF REQUEST
Request can be made on a monthly basis or up to one full year and is to be submitted prior to the beginning of each
fiscal year.
YEARLY Fiscal Year:
MONTHLY Start Date: End Date:
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, I verify that I will
sign up through eCentral for my allowances to be direct deposited monthly into my personal account.
Employee: Date:
APPROVAL SIGNATURES
Supervisor: Date: Approve: Yes
No
Vice President: Date: Approve: Yes
No
College President: Date: Approve: Yes
No
Financial Services Director: Date: Funds Available: Yes
No
ADDITIONAL COMMENTS
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