"Office of Research�s Petty Cash Request Form"
Office of Research Petty Cash Request Form Requestor: Date: Principal Investigator/Employee ID: Co-Principal Investigator/Employee ID: Project Title: Project #/Chartfield String: Budget Period: IRB #: Study Approved Period: Purpose for Petty Cash Usage: Total Amount Requested: Funds Needed By (date): Petty Cash Check will be made payable to Principal Investigator or Co-Principal Investigator only. You may designate an individual: to pick up check from the Office of Research/Sharon Jacobs, or request that the check be mailed to you at the following address: Contact for receipts and payment request form: Contact’s telephone number: Contact’s email: Signature, Principal Investigator or Co-Principal Investigator Date Attach the following to the Petty Cash Request Form: 1. Copy of Grant Budget Release Form (GBR) 2. Copy of IRB letter Return completed form, with attachments, to: Sharon Jacobs, Office of Research Phone: 974-5568, Fax: 974-4962 firstname.lastname@example.org PCR_032707 1