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Available Formats Form Name Form # Instructions Department Homepage Last Updated   * Accessor ID (ACID) Request 182 Information Technology at Purdue * Additional Pay Request Form Payroll Aug 2007 * Agent Inventory Form (for users of HEPA filtered cabinets) Radiological and Environmental Management Radiological and Environmental Management Jan 2005 Jan 2005 * American Income Claim Form RM26 Risk Management Mar 2003 * Application for Approval of a Flexible Schedule 2 School of Liberal Arts Business Office * Application for Special Event Liability Coverage RM15 Risk Management Aug 2001 * Application for Staff Child/Spouse Fee Remission 15 Bursar Office Jul 2004 * Application for Use of Laser Facility (LU-1) LU-1 Radiological and Environmental Management Jan 2005 * Application for Waiver of TIAA/CREF Three-Year Waiting Period Human Resources Nov 2005 * Application System Access Form 183 Information Technology at Purdue * Appointment to the Faculty 19 Human Resources May 2007 * Biological Safety Awareness Certification Radiological and Environmental Management Jan 2005 * Bio-Materials Pickup & Treatment Certification Form Radiological and Environmental Management Radiological and Environmental Management Jan 2005 Jan 2005 * Biweekly Payroll Certification Payroll Jul 2007 * Bowl Travel Form Travel Dec 2007 * Building Emergency Plan Template Radiological and Environmental Management Jan 2005 * Business Card Form Printing Services * Business Services Expectations/Acknowledgement of Responsibility (for staff on HR/Fin Zone) BSC - HR/Fin Zone * Business Services Service Request Form Business Systems Steering Committee Feb 2009 * Business Services Web Account Request Form BSC2 BSC - Business Services Computing Aug 2005 * Cancellation of Reciprocal Exemption from Withholding of Indiana Adjusted Gross Income Tax 52C Taxes * Capital Project Request For Assessment CPC-1 Physical Facilities Physical Facilities * Capital Projects Feasibility Assessment CPC-2 Physical Facilities Physical Facilities * Cash Acknowledgment UCO - University Collections Office Jan 2005 * Cash Advance Accounts Payable Apr 2008 * Cash Control Ledger UCO - Business Office for Student Organizations Sep 2006 * Cash Handling Expectations UCO - University Collections Office Nov 2007 * Cash Handling Manual UCO - University Collections Office Jul 2002 * * Cash Receipts Voucher (CRV) - NEW for SAP CRV Bursar Office Bursar Office May 2009 May 2009 * Central Files Request Freehafer Operations Apr 2005 * * Central Machine Shop Work Order 205 205 Physical Facilities Physical Facilities Oct 2008 Oct 2008 * Certificate of Residence (Neither work nor reside in Indiana) 52A Taxes May 2003 * Certificate of Residence (Reciprocal states of KY, MI, OH, PA, WI) 52 Taxes May 2003 * Certification for Missing Hospitality Receipt ECCO Nov 2003 * Change in Family Status CFS Human Resources Apr 2007 * Change in Family Status Form (Grad Staff Medical) Human Resource Services Apr 2009 * Check Request for Immigration Paperwork International Students and Scholars Aug 2007 * Chemical Hygiene Plan Awareness Certification Radiological and Environmental Management Jan 2005 * Chemical Inventory Form HCP-4 Radiological and Environmental Management Radiological and Environmental Management Jan 2005 Jan 2005 * Claim for Damage to Personal Property RM16 Risk Management Aug 2001 * Classify or Reclassify a Position HR10 Human Resources Nov 2004 * Coeus Access Request Sponsored Program Services * Confined Space Entry Permit (CS-1) CS-1 Radiological and Environmental Management Jan 2005 * Contest - Tournament Prize Form UCO - Business Office for Student Organizations Sep 2006 * Contract Addendum UCO - Business Office for Student Organizations Sep 2006 * Contract Review Checklist (restricted to IPFW campus only) Indiana Purdue Fort Wayne Mar 2001 * Cooperative Extension Service Accident/Incident Report Form RM27 Risk Management Mar 2003 * Cost Distribution Form CD_01 Costing May 2007 * Cost Override for Additional Payments Human Resources Dec 2007 * Credit Memo 56A Accounts Payable Feb 2007 * Criminal Conviction Check UCO - University Collections Office Feb 2005 * Customer Security Listing Request 184 Information Technology at Purdue * Deferment/Partial Cancelation for Early Intervention Employment UCO - Student Loans Apr 2005 * Deferment/Partial Cancellation for Child/Family Services Agency Employment UCO - Student Loans Apr 2005 * Deferment/Partial Cancellation for Law Enforcement Employment UCO - Student Loans Apr 2005 * Deferment/Partial Cancellation for Military and Volunteer Service UCO - Student Loans Apr 2005 * Deferment/Partial Cancellation for Nurse and Medical Technician Employment UCO - Student Loans Feb 2005 * Deferment/Partial Cancellation for Teaching Services UCO - Student Loans Apr 2005 * * Dependent Care FSA Claim Form Human Resources Human Resources Jul 2008 Jul 2008 * Deposit Form – PRF Account Cash & Checks PRF Aug 2007 * Development and Career Planning Worksheet Human Resources * Direct Debit Journal Voucher Accounts Payable Feb 2007 * Direct Deposit Authorization 0003 Payroll Jul 2007 * Disabled Child Physician's Form Human Resources Nov 2005 * Disclosure of Relationships with Outside Organizations 35 School of Education Business Office * Discretionary Fund Request Form PRF Jul 2007 * Discretionary Signature Authorization Form PRF Jul 2007 * DSS Training Request Form School of Liberal Arts Business Office * Earned Income Credit Advance Payment Certificate W-5 Taxes Jan 2005 * Employee Exposure Information HCP-5 Radiological and Environmental Management Jan 2005 * Employee Information Form 13 Human Resources Oct 2008 * Employee Right-to-Know Attendance Record HCP-8 Radiological and Environmental Management Jan 2005 * Expense Codes UCO - Business Office for Student Organizations Feb 2005 * F-1 Student Social Security Number Request TAX-SSN1 Taxes Dec 2004 * Family and Medical Leave Act (FMLA) Forms Human Resources Apr 2005 * Federal Perkins Deferment UCO - Student Loans Jan 2005 * Federal Tax Withholding (Page 1) W4 Taxes Jan 2009 * Federal Tax Withholding (Page 2) W4 Taxes Jan 2009 * Feedback for Supervisor Human Resources * Fellowship Action Form FA Human Resources Oct 2008 * Financial Systems Access Delete Request 4D Accounting Services May 2003 * Financial Systems Access Request 4 Accounting Services May 2003 * Fire Department Confined Space Entry Data (CS-2) CS-2 Radiological and Environmental Management Jan 2005 * First Report of Injury Form Radiological and Environmental Management Jan 2005 * FMBB Budgeting Workbench Budget and Fiscal Planning Jan 2007 * FMLA Forms Human Resources Apr 2005 * Form 23 23 Mail Services Jun 2007 * Form A-1 Project Summary & Evaluation for Use of Radioactive Materials and Radiation Producing Devices(New/Amend Project Form) A-1 Radiological and Environmental Management Apr 2006 * Form A1-S Radiation Facility Approval Request (New Lab Application) A-1-S Radiological and Environmental Management Jan 2005 * Form A-4 Application to Use Radioactive Materials and/or Radiation Producing Devices (New User Application) A-4 Radiological and Environmental Management Apr 2006 * Form SM-1 Survey Meter Registration Form SM-1 Radiological and Environmental Management Apr 2006 * Forms/Supplies Request Freehafer Operations Jan 2009 * FSA Auto Reimbursement Waiver/Election Form Human Resources Jan 2006 * FSA Direct Deposit Authorization Human Resources Jan 2006 * Fund Raising Sales Agreement with Credit Card UCO - Business Office for Student Organizations Jul 2008 * Fund Raising Sales Agreement without Credit Card UCO - Business Office for Student Organizations Jul 2008 * Funds Commitment Form FMZ1 Purchasing Services Feb 2008 * General Waiver, Release, and Hold Harmless Form RM29 Risk Management Apr 2002 * Generic @Purdue Account Form (for staff on HR/Fin Zone) BSC - HR/Fin Zone Aug 2002 * Gift-In-Kind and Loan Report 41B University Development Office * Graduate Fellowship Assignment 90 Graduate School May 2009 * Graduate Staff Accident Insurance Brochure RM19 Risk Management Aug 2003 * Hazard Clearance Certificate (Clean Sheet) - This form assures equipment being submitted for maintenance or repair is free from contamination. Radiological and Environmental Management Jan 2005 * Hazardous Material Pickup Request (HMM-001) HMM-1 Radiological and Environmental Management Radiological and Environmental Management Radiological and Environmental Management Jan 2005 Jan 2005 Jan 2005 * * Health Care FSA Claim Form Human Resources Human Resources Jul 2008 Jul 2008 * Health Professions Deferment UCO - Student Loans Jan 2005 * I-9 Human Resources Feb 2009 * In Case of An Accident Brochure RM18 Risk Management Aug 2001 * Income Codes UCO - Business Office for Student Organizations Feb 2005 * Indiana Withholding Exemption & County Status Certificate WH-4 Taxes Feb 2004 * Inventory & Sales Control Worksheet UCO - Business Office for Student Organizations Sep 2006 * Invoice Voucher (IV) 56 Accounts Payable Feb 2007 Laboratory Door Posting Radiological and Environmental Management Jan 2005 * LAN Account Form (for staff on HR/Fin Zone) BSC - HR/Fin Zone * Laser System Registry (LS-1) LS-1 Radiological and Environmental Management Jan 2005 * Laser Use Application (LU-2) LU-2 Radiological and Environmental Management Jan 2005 * Leave Action Form Human Resources Dec 2008 * Lecturer Appointment 19L Human Resources May 2007 * Medical Treatment Authorization Form RM28 Risk Management Oct 2001 * Non-Permit Confined Space Certification (CS-3) CS-3 Radiological and Environmental Management Jan 2005 * Non-Purdue Student Employment Form Human Resource Services Jan 2008 * Notice of Non-Renewal of Contract 19E Human Resources * Occupational Health Program - Animal Exposure Participation/Declination Form Radiological and Environmental Management Jan 2005 * Occupational Health Program - Animal Exposure Risk Assessment Form Radiological and Environmental Management Jan 2005 * Off-Cycle Payment Request Form Payroll Mar 2009 * Office Worker Ergonomics Questionnaire Radiological and Environmental Management Jan 2005 * OnePurdue Role Request Form BSC - Business Services Computing Jan 2007 * OnePurdue Timecard Payroll Jun 2007 * Out of Network Reimbursement Form Human Resources Oct 2006 * PageCenter Access Form - Development 183a Information Technology at Purdue May 2002 * PageCenter Access Form - Financial 183a Information Technology at Purdue May 2002 * PageCenter Access Form - Human Resource 183a Information Technology at Purdue May 2002 * PageCenter Access Form - Student 183a Information Technology at Purdue May 2002 * Parent Boilermaker Direct Deposit Authorization Agreement Bursar Office * Participant Roster UCO - Business Office for Student Organizations Sep 2006 * Payee Certification PC Taxes Oct 2007 * Payroll Distribution Change (PDC) 65 Costing Mar 2007 * Performance Coaching and Feedback Worksheet Human Resources * Performance Planning Worksheet Human Resources * Performance Summary Human Resources * Permit Confined Space Entry - Contractor Debrief (CS-4) CS-4 Radiological and Environmental Management Jan 2005 * Personnel Action Form PA Human Resources Oct 2008 * Personnel Activity Report (SAP PAR) Costing May 2009 * Personnel Change Request PC Human Resources May 2007 * Petty Cash Reimbursement Form Indiana Purdue Fort Wayne Indiana Purdue Fort Wayne May 2007 May 2007 * PHCS Provider Nomination Form Human Resources * Physical Facilities Prescription Safety Glasses Authorization Form 52 Radiological and Environmental Management Sep 2006 * Post-Only Form HR2 Human Resources Nov 2004 * PPE Certification of Hazard Assessment (Location) Radiological and Environmental Management Jan 2005 * PPE Certification of Hazard Assessment (Location) - Template Radiological and Environmental Management Jan 2005 * PPE Certification of Hazard Assessment (Position/Title) Radiological and Environmental Management Jan 2005 * PPE Certification of Hazard Assessment (Single Task) Radiological and Environmental Management Jan 2005 * PPE Certification of Training Radiological and Environmental Management Jan 2005 * PRF Account Deposit Form for Cash & Checks PRF Aug 2007 * Principal Investigator Letter of Certification (HMM-005) HMM-5 Radiological and Environmental Management Jan 2005 * Procedures for Cash Payments Over $10,000 UCO - University Collections Office Feb 2005 * Procurement Decision Document Purchasing Services Feb 2008 * Professional Services Selection Summary Purchasing Services Jan 2007 * * Property Off Campus POC Accounting Services Accounting Services Mar 2007 Sep 2006 * Proposal Budget Worksheet Sponsored Program Services * Proposal Transmittal Checksheet Sponsored Program Services Jul 2002 * Prudential Short Form Health Statement Human Resources Feb 2005 * Public Folder Request (for staff on HR/Fin Zone) BSC - HR/Fin Zone * Public Record Request Public Records Officer and Director Business Manager Jun 2005 * Purchasing Requisition 12 Purchasing Services * Purdue Health Plan EZ Claim Form Human Resources Feb 2004 * Purdue Person Search (PPS) Access Request Form Student Services Technology & Assessment * Purdue Student Loan Deferment UCO - Student Loans Jan 2005 * * Purdue University Bus Request 1B 1B Transportation Services Transportation Services Feb 2007 Feb 2007 * Quota Correction Form Payroll Jun 2007 * Quota Payroll Request Form Payroll Aug 2007 * Radioactive Materials Ordering Form R-1 Radiological and Environmental Management Jan 1995 * Radioactive Waste Pickup Request Radiological and Environmental Management Radiological and Environmental Management Jan 2005 Jan 2005 * Re-Certification of Cash Handling Plan UCO - University Collections Office Mar 2005 * Recommendation for Special Merit Pay Increase 12SMP Human Resources Jan 2004 * Record of Dues Collected UCO - Business Office for Student Organizations Sep 2006 * Refrigerator/Freezer Poster - FLAMMABLE SAFE & NO FOOD Radiological and Environmental Management Jan 2005 * Refrigerator/Freezer Poster - NO FLAMMABLES Radiological and Environmental Management Jan 2005 * Refrigerator/Freezer Poster - NO FOOD Radiological and Environmental Management Jan 2005 * Reimbursement for Prospective Employees 17C Taxes Jun 2007 * Release 1 New Hire Spreadsheet Human Resources Dec 2006 * Release 1 Termination Spreadsheet Human Resources Dec 2006 * Remote Job Entry File Access Request 653 Information Technology at Purdue * Rental Vehicle Insurance Card RM25 Risk Management Aug 2001 * Report of Cash Payments Over $10,000 Received in a Trade or Business 8300 UCO - University Collections Office Dec 2001 * Report of Personal Injury For Students or Visitors RM30 Risk Management Sep 2007 * Report These Materials (Reportable Materials) Radiological and Environmental Management Radiological and Environmental Management Jan 2005 Jan 2005 * Request and Leave Action form (RLA) for Sabbatical, Research Leave, Outside Activity Leave or Change in Duty Station RLA Human Resources Human Resource Services Dec 2008 Dec 2008 * Request Authority to Travel on University Business **CURRENT FORM** 17 Travel Dec 2007 * Request for Absence from Campus 33ABSENCE Human Resources Human Resources Jun 2007 Jun 2007 * Request for Advance Payroll Jun 2007 * Request for Advance Travel Funds 1000 PRF Travel Sep 1999 * Request for American Income Medical AD&D Coverage RM05 Risk Management Aug 2001 * Request for Approval for Consulting Services RCS Taxes Oct 2007 * Request for Award or Prize Payment to Student 79A Financial Aid Jul 2008 * Request for Certificate of Insurance RM02 Risk Management Jun 2009 * Request for Electronic Funds Transfer 52A Treasury Operations Mar 2007 * Request for Estimate of Benefits Human Resources Mar 2005 * Request for Exception to Nonexempt Pay Scales Human Resources Apr 2008 * Request for Non-employee to Operate P.U. Vehicle RM01 Risk Management Oct 1997 * Request for Notice to Proceed 27 Sponsored Program Services Aug 1994 * Request for Privileges BSC - Business Services Computing Jun 2007 * Request for Professional Services RPS Physical Facilities Jun 2009 * Request for Scholarship Payments to Students 79S Financial Aid Jul 2008 * Request for Scholarship, Award or Prize - International Student 79INT Taxes Jul 2008 * Request for Service Information Technology at Purdue Aug 2004 * Request for Services 77 Telecommunications * Request for Student Professional Liability Coverage RM17 Risk Management Aug 2001 * Request for Study Abroad Coverage RM23 Risk Management * Request for Taxpayer Identification Number and Certification W-9 Accounts Payable Jan 2003 * Request Student/Borrower's SSN & Certification W-9S Bursar Office Oct 2000 * Request to Add/Delete/Change Directory and/or Role Structure (for staff on HR/Fin Zone) BSC - HR/Fin Zone Nov 2006 * Request to Change Order 26 Purchasing Services Nov 2008 * Request to Change Status of University Property ECS Accounting Services Mar 2007 * Request to Claim Electronic Funds over 90 Days Old Treasury Operations Nov 2007 * Resource Request (for staff on HR/Fin Zone) BSC - HR/Fin Zone * Salary Reduction Agreement Human Resources Jun 2007 * Scholarship Form UCO - Business Office for Student Organizations May 1994 * School of Technology at New Albany non-resident fee remission form Bursar Office * School of Technology at Richmond non-resident fee remission form Bursar Office * Self Identification Compliance Form Human Resource Services Apr 2009 * Self-Audit Checklist (3 Pages) Radiological and Environmental Management Jan 2005 * Separation of Duties - Schedule A UCO - University Collections Office Jul 2002 * Separation of Duties - Schedule B UCO - University Collections Office Jul 2002 * Service Contract UCO - Business Office for Student Organizations Feb 2005 Shipping (Packing List) Physical Facilities Jun 2000 * Signature Authorization 0009 Accounting Services May 2004 * Signature Authorization - Fort Wayne Regional Campus 0009A Fort Wayne Regional Campus Nov 1986 * Signature Delegation Form CSSD Costing Feb 2007 * Significant Financial Interest Disclosure 2 Sponsored Program Services * Special Fee Refund Template Director, Business Managers Feb 2005 * Stores Requisition Form 100 Physical Facilities * Student Boilermaker Direct Deposit Authorization Agreement Bursar Office * Student Hiring Form Human Resources Jul 2007 * Student Loan Repayment Brochure UCO - Student Loans Mar 2004 * Student Release Form Bursar Office * Student Social Security Number Request (F1 Visa Holders Only) TAX-SSN1 Taxes Dec 2004 * Study Abroad Insurance Waiver RM24 Risk Management Aug 2001 * Summer Savings Enrollment Form Payroll Jun 2007 * Supplemental Loan Information Form UCO - Student Loans Jan 2005 * Supplier Request Form Purchasing Services Feb 2008 * Telephone Log Sheet UCO - Business Office for Student Organizations Feb 2005 * Terminal Services Access Request Form (for staff on HR/Fin Zone) BSC - HR/Fin Zone * Time Certification Payroll Jun 2007 * Transport Document for Intra-Campus Shipments Mail Services * Transportation Request 1 Transportation Services Jan 2000 * Travel - Missing/Lost Receipt Form 25MR Travel * Travel Reimbursement Request **CURRENT FORM** 25 Travel Dec 2007 * Turbine Flight Operations (TFO) TFO1 Technology Business Office Aug 2008 * Unexpended Funds Transfer Request Form Sponsored Program Services Jul 2008 * Verification of Equipment Non Availability Purchasing Services Jun 2007 * Vision Service Plan (VSP) Claim Form Human Resources Feb 2004 * Voluntary Support/Gift Report 44 Sponsored Program Services * Waiver of Competitive Bid Purchasing Services * WebView Request Form CF01 Freehafer Operations Oct 2007 * Worker's Compensation First Report of Injury Reporting Form Physical Facilities Physical Facilities * Worker's Compensation Witness Report Form Human Resources Jul 2008