FUND OR REVENUE ACCOUNT
REQUEST TO ESTABLISH/CHANGE/LINK/DELETE

School/Organization		Date prepared		
Department		Effective date		
Prepared by		Telephone		

ESTABLISH NEW FUND

Title of new fund		

Statement of Justification
Describe program or activity that will create the source of funds, estimate amount of income to be collected, and state the anticipated period of operation.  Explain the necessity for the new fund as related to program objective, i.e., there is no other available source or supplier. (Explanation should not exceed three lines.)

	

	Link new fund with existing expense account number(s) 		

	Link new fund with new expense account number (attach Expenditure Account Request)	

ESTABLISH NEW REVENUE ACCOUNT

Title of new revenue account		

	Link new revenue account with existing fund number 		

CHANGE TITLE OF EXISTING FUND OR REVENUE ACCOUNT 		

Account number		Change title to		

If funding source has changed, provide a Statement of Justification above.

DELETE ACCOUNT/FUND

	Delete fund number 		

	Delete revenue account number 		

	Delete linkage of account number 		with fund number		

Department	
	
General Ledger Code			

Authorized Signature			

SOM Dean's Office 			
	(required for School of Medicine departments only)		
Budget Office			
Approved			
	
Accounting Office
Account/Fund assigned 		
Approved		
Date