Systems and Procedures
A Division of The Corporate Controller's Office


Form Instructions

  1. Employee Name - Enter the name of the employee requesting a cellular device.
  2. PSU ID – Enter the employees’ PSU ID number.
  3. Employee Title – Enter the employees’ title.
  4. Email – Enter the employees’ email address.
  5. Department Name – Enter the department name.
  6. Admin Area – Enter the administrative area of the employee.
  7. Cell Phone # - Enter the cell phone number (if applicable).
  8. Categorize the business need for cellular services (check all that apply) – Check any and/or all of the following six options: Check box 1 for frequently engages in work-related travel. Check box 2 for frequently out of office on Penn State business. Check box 3 for member of key personnel needed in the event of an emergency. Check box 4 for position requires work off-site at location(s) with no communication. Check box 5 for works from home for convenience of the University. Check box 6 for other and provide a description.
  9. Rationale (required) – Provide rationale for business need for cellular services (separate memo may be attached). There are two lines available for this information.
  10. Services being requested check boxes additional information. There are two options available: check box 1 for a new service request or check box 2 for a continuing service request and proceed to next step.
  11. Check box 1 for Cellular Phone Service and enter the name of the provider/vendor. If the Other Cellular Services box was checked, describe the services. One line is provided for this information.
  12. Other Cellular Services provided by: Enter the name of the provided/vendor providing the “other” cellular services. One line is provided for this information.
  13. Account to be charged for services box – Enter the following information on the appropriate line. Line 1: Enter the Account to be charged for service. Line 2: Estimated cost of monthly service. Line 3: Estimated cost of equipment.
  14. Employee Signature. Print the completed page. The employee then signs and dates the form.
  15. Department Head or Supervisor: The Department Head of Supervisor of the employee must approve the form.
  16. Budget Executive/Financial Officer/Director of Business Services: The Budget Executive and either the Financial Office (University Park) or the Director of Business Services (Non-UP campuses) must sign and date the form.
  17. Office Use Only: Enter the date service ended and the date equipment returned when applicable.
Image of Cellular Usage Agreement University Provided Service Dedicated Device for Employee Form