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| Please indicate
the type of reimbursement you are requesting: |
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| Home computer Internet access: | 640250 |
$
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(Monthly Fee) * |
| Personal cell phone use for campus business: | 640220 |
$
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(Monthly Fee) * |
| Equipment Reimbursement | 640220 |
$
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(One-Time Only) |
| Manufacturer Model | |||
| * THE DEPARTMENT WILL DETERMINE THE MONTHLY FEE | |||
| Employee Name: | Employee Campus ID No: | |
| Employee Address, City, State & Zip: | ||
| Employee Signature: ______________________________ | Date: __________ | |
| This agreement is
effective until the end of the fiscal year, or until the employee separation
or transfer to another department; whichever occurs first. Please notify
Accounts Payable, mail Drop 8202, promptly should the employee separate
or transfer. Payments will be made every two months and mailed to the employee's home address. Payments will be processed each August 30, October 31, December 20 (due to campus closure), February 28, April 30, and June 30. |
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Required Fields:
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ACCOUNT:
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FUND:
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DEPT ID:
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*
PRGM:
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CLASS:
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PROJECT/GRANT:
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REQ
#:
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| Please Choose: |
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| REQUIRED SIGNATURES: |
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Financial Manager Approval: __________________________________________________________________ |
Date: __________ |
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| Print Name: | ||
| President or Appropriate Vice-President Approval:
_______________________________________________ |
Date: __________ | |
| Print Name: | ||
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Please return this form to Accounts Payable, Mail Drop 8202 |
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