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


Form Instructions

  1. Department Name - Enter the name of the department requesting a pooled device for general departmental use.
  2. Admin Area - Enter the name of the Administrative Area.
  3. Person Submitting Request - Enter the name of the individual submitting the request for pooled device for general department use form.
  4. Email – Enter the email address of the individual submitting the request.
  5. Rationale – This field is required. Provide rationale for needing a polled service/device for the department. There are four lines for descriptive text.
  6. Services being requested check boxes. Check either the Cellular Phone Services or Other Cellular Services box.
  7. Services being requested check boxes additional information. If the Cellular Phone Service box was checked above, enter the name of the provider/vendor. If the Other Cellular Services box was checked, describe the services.
  8. Other Cellular Services provided by: Enter the name of the provided/vendor providing the “other” cellular services.
  9. Phone Number of Device (if applicable): Enter the phone number of the device if applicable.
  10. Account to be charged: Enter the account/budget code to be charged.
  11. Describe how pooled device will be monitored and assigned: There are four lines for descriptive text to describe how the pooled device will be monitored and assigned.
  12. Budget Administrator/Department Head: After this form is printed, the Budget Administrator/Department Head must approve the request by signing and dating this form.
  13. 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.
  14. Office Use Only: Enter the date service ended and the date equipment returned when applicable.
Image of Cellular Usage Agreement University Provided Service Pooled Device for General Departmental Use Form