Page 1 of 3 Policy Routing Form
Aug 2019
Received by:
Date
Via: campus mail / hand-delivery / e-mail
Policy Development & Adoption Routing Form
Please complete this form and submit it to the Office of Legal Affairs. Completed forms and supporting
documentation will be forwarded to the Policy Review Committee (PRC). For questions about this form or the
ASU Policy Development & Adoptions Procedures, contact the Office of Legal Affairs at 229-500-3502.
Policy Initiator: __________________________ Submission Date: _______________________
Telephone Number: _______________________ Email Address: _________________________
Request Type (select one):
Revision to an Existing Policy (attach existing policy)
Creation of a New Policy (attach drafted policy)
Reason for Request (select all that apply):
Attach documentation supporting the reason for a revision to an existing policy or creation of a new policy.
New Initiative Changes to Law
Accreditation Requirement Other ________________________
Expedited, Emergency or Interim Policies (if applicable):
The ASU Policy Development & Adoptions Policy, Section 6, states that expedited, emergency or interim
policies may be justified under special circumstances, including, but not limited to: the health and welfare of
the university community, regulatory requirements which mandate a time-sensitive compliance deadline, cases
involving university liability, advice of legal counsel, or other fully defined emergency situations. If you are
requesting that your proposal be reviewed under one of the above-mentioned special circumstances, please
provide your rationale below and attach supporting documentation.
Constituent Groups: (if applicable)
List the constituent group/s that reviewed the proposed policy as an informational item.
Please provide comments below. If more space is needed, please use an additional sheet of paper.
Page 2 of 3 Policy Routing Form
Aug 2019
Shared Governance Body (if applicable):
Please provide comments below. If more space is needed, please use an additional sheet of paper.
Faculty Senate
Chair’s Signature: ______________________________ Date: ___________________
Staff Council
Chair’s Signature: ______________________________ Date: ___________________
Student Government Association
President’s Signature: ___________________________ Date: ___________________
Shared Governance Body’s Comments:
University Administrators (required):
The endorsement and signature of the area Vice President/s is required before submission to the PRC.
Please provide comments below. If more space is needed, please use an additional sheet of paper.
Provost & Vice President for Academic Affairs
Signature: ______________________________ Date: ___________________
Senior Vice President for Administration
Signature: ______________________________ Date: ___________________
Vice President for Enrollment Management
Signature: ______________________________ Date: ___________________
Vice President for Student Affairs
Signature: ______________________________ Date: ___________________
Vice President for Information Technology Services/CIO
Signature: ______________________________ Date: ___________________
University Administrators Comments:
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Page 3 of 3 Policy Routing Form
Aug 2019
Policy Review Committee (PRC): The PRC’s must review all ASU policy proposals.
Please provide comments below. If more space is needed, please use an additional sheet of paper.
Policy Review
Approved Not Approved Date: ___________________
Additional Review (if needed)
Approved Not Approved Date:
___________________
Is a review by the President’s Executive Cabinet needed? Yes No
PRC Chair or designee:
Signature: ___________________________________ Date: ___________________
PRC Comments:
President’s Executive Cabinet: Please provide comments below. If more space is needed, please use an
additional sheet of paper.
Policy Review
Approved Not Approved Date:
Additional Review (if needed)
Approved Not Approved Date:
President or designee:
Signature: ___________________________________ Date: ____________________
President’s Executive Cabinet Comments:
For Office of Legal Affairs Use Only:
Assigned Policy Classification/Number: __________
Date of University-wide Publication: _______
Completed by:_______________________________ Title:_________________________________
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