Form Instructions

Print the form and complete as follows:

1. 1. Fill in effective date: This is the date the Fund-Program-Dept code is to become active or current date if immediate.
   2. Check one of the four reasons (in bold) for the request and any items listed below the checked item.
      1. Request for change in Fund-Program-Dept code name
         include the Fund-Program-Dept to be changed and state the new name of the Dept
      2. Request for change in authorized signature
         include the Fund-Program-Dept code to be changed, include all requested authorized signers.
      3. Request to close out a Fund-Program-Dept code
         include Fund-Program-Dept to be closed include necessary forms to close out any remaining revenue, expenditure or cash balances.
      4. Request for a new Fund-Program-Dept code
         complete all fields as indicated below:
         • Select Department or Project:
           If you are requesting a new department code (long term activity) place an X in front of department, if you are requesting a new project code (short term activity) place an X in front of project.
         • Describe proposed use of the Dept and the reason it is necessary:
           The need for the new Fund-Program-Dept must either be a new program, a new grant, or of a significant dollar or transaction amounts that separate recording and reporting is necessary. All requests will be reviewed based on the information supplied with the request form to determine if a new Dept is needed or if the activity can be combined with an established Fund-Program-Dept.
         • Source of Funding:
           This determines the Fund assigned to the Dept. Is it GPR funds, a Federal grant or non-federal grant, a gift, or program revenue? Be specific as to the source of the funds. Include a complete statement of how revenue will be generated and how rates were determined.
         • Fund-Program-Dept Name:
           Use a name that is an indication of its use so it is easily recognized.
         • Include all authorized signers:
           Include all names that can sign for expenditures.
         • Project period of Fund-Program-Dept:
           If Dept is to be kept open for a certain period of time, include those dates. If there is no set time period, leave this field blank.
         • Manager name:
           Person responsible for monitoring Dept for proper activity . Also include the appropriate department.
         • If this is a fund 128 Dept, include the Auxiliary report number
           the code is to be added to. (If unsure, contact Jodi Sumpter @ 5785).
           Fund 128 interest earnings. (If unsure, contact Jodi Sumpter.)
   3. Signature of Requester: Person requesting the new Fund-Program-Dept

Once the form is signed by the Division Budget Contact, make a copy to keep and submit the original to Financial Services, Hyer Hall 110. A copy will be returned when all activity has been completed by Financial Services.