Nazareth Cellular Phone/PDA Allowance Request Form (rev. 9/18/15)
NOTE:  FOR USE WITH OPTION B
 
Refer to the Nazareth Cellular Phone Policy for information about policies regarding cell phone and PDA/Data Plan service. 
 Employee Name & Cell Phone #:  Employee ID #:   			Employee Department Name 

 Job Title:			      Exempt Employee: Indicate (Y)/(N):		  

 Business Purpose/Justification: Provide the reason this employee qualifies for an allowance:   

 
General ledger account number: 	Fund        		Unit                 		Object

 11	 	 
53060	

 Allowance option: Indicate option(s) (i.e., phone and internet) and amount for each:  
1.  Cellular Phone Only (up to $40/month: $ 	
2.  Cellular/Data Device (up to $80/month): $ 	
 
Time Period for this allowance:     
Start Date		End Date:    		Total Allowance Amount (amount/month X # of months) 

NOTE: The annual amount covers the time period requested above. If no dates are provided, the start date will be the first pay period following receipt of this form in the Controller’s Office; the end date will be June 30th of the fiscal year. Requests cannot cross fiscal years. Submit a new Allowance Request Form to the Controller’s Office each year.  
 =============================================================================================== 
Employee Certification: 
I certify that I require the service for which I am receiving an allowance to conduct official Nazareth College business. I will use a secure passcode on my device and will promptly advise my supervisor if I discontinue my cellular phone or PDA/data plan service. 
Employee Signature:      				Date: 

Supervisor Certification: 
I certify that the above-named employee requires the service indicated to conduct official Nazareth College business. I will notify the Controller’s Office immediately, in writing, if the allowance(s) should end prior to the end date indicated on this form. Note: If the employee is a dean or vice president, only the Authorized Approval signature is required and this Supervisor signature may be left blank. 
Supervisor Signature:                                              Date: 

 
Authorized Approval:                                              Date:  

Deans/Vice Presidents must approve allowance requests for employees within their college/division. The Vice President for Academic Affairs will approve allowance requests for the Deans; the President will approve requests for the Vice Presidents.   

Send the completed form, with the appropriate approvals, to the Controller’s Office for processing.