UNIVERSITY OF MASSACHUSETTS / AMHERST
Fiscal Administrator Signature Delegation Form
*This form delegates authority on the funds listed on this form from the responsible person on these funds to the delegated person specified below.
*This delegation is only valid for the effective dates given or until a permanent change is made in the responsible person.
*This delegation will not be valid unless all necessary signatures are included on this form.
*This form can not be used to delegate supervisory authority.
NOTE: This delegation procedure does not exempt the responsible person from any responsibility.
The responsible person listed below remains on all records to be the responsible person and remains fully responsible for transactions against the funds
listed on this form.
Information on Responsible Person (Person delegating signature authority):
Name:
Last First Date
Department:
Employee #: Phone:
SIGNATURE:
Information on Delegate Person (Person now allowed to sign):
Name:
Last First Date
Department:
Employee #: Phone:
SIGNATURE:
Effective Dates: Beginning: Ending: Indefinitely:
This section must be completed if one of the above signatures is not available:
MBU Head or VC Name:
Signature:
Reason signature was not available:
Specify Level of Delegation:
All Chartstrings in AEXE: or
}
All Chartstrings in ADIV: or (Excludes Sponsored Projects- List
All Chartstrings in AMBU: or Sponsored Projects separately or by
All Chartstrings in ADPT: or DeptID)
All Chartstrings in ASEG: or
All Chartstrings for DeptID:
List Individual Chartstrings here (DeptID / Fund / Project Grant Combinations):
DeptID Fund Project Grant DeptID Fund Project Grant
Specify Type of Delegation:
Finance (A/P, Procurement, Recharge Only) Personnel (Only) Both Finance & Personnel
NOTE: Use back for additional DeptID's or individual Chartstrings.
When completed send this form to: Controller's Office, Room 405 Goodell Building - Attn: Joanne Wheeler Rev. 04/2010
Additional DeptID's
DeptID DeptID DeptID DeptID
Additional Individual Chartstrings
DeptID Fund Project Grant DeptID Fund Project Grant