Organization Request Form

Name ________________________________ Department ___________________________

e-mail address _________________________ Phone number _________________________

Request Type (circle one):

Add new Organization

Move an Existing Organization

Eliminate an Existing Organization

Organization Name (restrict to 30 characters) _________________________________

Organization Number (if known) __________________

Address (Building, room) ___________________________

Phone Number ____________________________________

Effective Date of Action ____________________________

Reason for Change ____________________________________________________________

___________________________________________________________________________

Source of Funds/Budget __________________________________________SUNY Account # _________

Positions Affected _______________________________________________________________________

_____________________________________________________________________________________

If ending an organization- Are the positions and staff assigned to this organization to be eliminated or moved?
If moved - list the affected positions, employees and the new organization

If new - Are existing staff being shifted to the new organization?
If yes please provide a list of the positions and the employees affected.
If new positions are to be created, please provide the HR Master Position web form with the requested title and duties description
If moving an organization, provide a list of all positions and employees to be moved. Also indicate what is to be done with any position not being moved along with the organization.

Requestor Signature ____________________________________ Date__________

Vice President Signature for Approval __________________________________ Date__________