Cellular Telephone Request And Justification Form

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Stephen F. Austin State University
Cellular Telephone Request and Justification Form
Employee Name: _________________________ Campus ID: __________________________________
Department: ____________________________ Job Title: ____________________________________
Justification for issuance of cellular telephone or wireless communications device:______________
____________________________________________________________________________________
____________________________________________________________________________________
Description of cellular telephone/wireless communications device and plan(s) requested:________
____________________________________________________________________________________
____________________________________________________________________________________
All charges for cellular telephone and wireless communications devices are the responsibility of
the department.
Employee’s Certification and Signature:
I understand this is an official Stephen F. Austin State University provided communication device.
Unauthorized use is prohibited, usage may be subject to security testing and monitoring, misuse is
subject to criminal prosecution, and there is no expectation of privacy except as otherwise provided by
applicable privacy laws. As such, I certify that I have read, understand, and will comply with SFA’s
Cellular Telephones and Wireless Communication Devices Policy (F-42) and Communication
Services Policy (F-29).
Signature:_______________________________ Date: _____________________________________
Supervisor’s Certification and Signature:
I certify that the requested cellular telephone/wireless communications device is needed for this
employee to conduct official university business. I authorize charges for the cellular telephone/wireless
communications device to be paid from the departmental account listed below. I have read, understand,
and will comply with SFA’s Cellular Telephones and Wireless Communication Devices Policy
(F-42) and Communication Services Policy (F-29).
Account number to charge: ____________________________________________________________
Date: ____________________________________
Signature:_______________________________
Vice President or President’s Approval
I authorize issuance of the cellular telephone or wireless communications device:
Signature:_______________________________ Date: ____________________________________
Equipment Receipt:
This device, __________________________________________________________ ,was picked up by:
Signature:_______________________________ Date: ____________________________________
Please send completed form to: Assistant Director of Telecommunications and Networking, Box 6095
2/2012

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