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									                                                              Cal Poly Pomona Foundation, Inc.
                                                                                    "Quality Service Supporting Quality Education"

                                            GRANT AND CONTRACT ACCOUNTS/FOUNDATION PROGRAM FUNDS
                                             APPOINTMENT AUTHORIZATION/EFFORT CERTIFICATION FORM
SECTION A: (TO BE COMPLETED AS SOON AS THE ASSIGNMENT FOR THE QUARTER IS DETERMINED)

ASSIGNED TIME AUTHORIZED:


DATE                                                       January 7, 2011              EMPLOYEE NAME


DIRECT SUPERVISOR                                                                       PEOPLE-SOFT EMPLOYEE ID NUMBER


FOUNDATION PROJECT NUMBER                                                                   AY FACULTY                    12-MONTH EMPLOYEE                      OTHER APPT TYPE



NAME OF PROJECT                                                                         ACADEMIC QUARTER



FIRMS PROGRAM CODE                                                                      NUMBER OF WTU'S ASSIGNED DURING QUARTER


PREPARED BY                                                                             PERCENT OF TIME TO BE REIMBURSED FROM GRANT                                          0.00%
                                                                  Signature


                                                                                        PERCENT OF TIME TO BE COLLEGE/DEPT COST SHARE                                        0.00%


EMPLOYEE                                                                                EST REIMBURSEMENT TOTAL FOR QUARTER
                                                                  Signature                                                                                         Salary                    Benefits



                                                                                        PEOPLE-SOFT EMPLOYEE POSITION NUMBER

MGR/GRANTS AND CONTRACTS
                                                                  Signature             UNIVERSITY REIMBURSEMENT CHARTFIELD STRING

SECTION B: (TO BE SIGNED & SUBMITTED AFTER THE QUARTER ENDS)                                                                                  UNIVERSITY USE ONLY
                                                                                                                                                BILLING REQUEST
DISTRIBUTION OF EFFORT:                                                ACADEMIC            PERCENTAGE                        TOTAL                                 TOTAL                  REIMBURSEMENT
                                                                       QUARTER               WORKED                          SALARY                               BENEFITS                    TOTAL
PERCENTAGE OF EFFORT:                                                                                                     Total to be Reimbursed to the Univ from the Foundation Account for Period

A.    GRANT REIMBURSED AMOUNT :

                                                                                                   0.00%
  Project Number                                                          Quarter

B.    COST SHARING:

                                                                                                   0.00%
  Project Number                                                          Quarter


C. OTHER GRANT RELATED ACTIVITY (TO BE SUBMITTED ON A SECOND FORM)

                                                                                                   0.00%
  Project Number                                                          Quarter



D.   NON-GRANT UNIVERSITY ASSIGNMENTS (TEACHING/ADMINISTRATION/OTHER):

              Teaching/Administration                                                              0.00%
  Type of Assignment                                                      Quarter
                                                                                                                                       TOTAL CALCULATED BY UNIVERSITY BUDGET

                                            TOTAL        (MUST EQUAL 100%)                         0.00%
                                                                                                               $                                         $                            $


CERTIFICATION OF EFFORT:
I HEREBY CERTIFY THAT THE PERCENTAGE OF TIME INDICATED ABOVE REPRESENTS THE ACTUAL DISTRIBUTION OF EFFORT I WORKED DURING THE PERIOD SPECIFIED ON THIS REPORT; THAT THE
WORKLOAD SPECIFIED FOR THE GRANT PROJECT IS THE ACTUAL PERCENTAGE OF TIME WORKED ON THE PROJECT; AND THAT THIS DISTRIBTUION OF EFFORT DIRECTLY BENEFITTED THE PROJECT.




EMPLOYEE
                                            Employee                                                                            Date




I HEREBY CERTIFY THAT I HAD FIRST-HAND KNOWLEDGE OF ALL WORKED PERFORMED BY THIS EMPLOYEE AND THAT THE DISTRIBUTION OF EFFORT INDICATED ABOVE REPRESENTS THE ACTUAL
WORK PERFORMED DURING THE PERIOD COVERED BY THIS REPORT.




DIRECT SUPERVISOR
                                            Supervisor                                                                          Date




COLLEGE DEAN/VICE PRESIDENT
(If not direct supervisor, othervise N/A)   Dean/Vice President                                                                 Date




FOUNDATION ACCOUNTING                                                                                                    UNIVERSITY BUDGET
                                            Signature                                           Date                                                 Signature                                  Date
                                                                                                                                                                                                         Rev. 06/10
                                                              Cal Poly Pomona Foundation, Inc.
                                                                                    "Quality Service Supporting Quality Education"


                                            GRANT AND CONTRACT ACCOUNTS/FOUNDATION PROGRAM FUNDS
                                             APPOINTMENT AUTHORIZATION/EFFORT CERTIFICATION FORM
SECTION A: (TO BE COMPLETED AS SOON AS THE ASSIGNMENT FOR THE QUARTER IS DETERMINED)

ASSIGNED TIME AUTHORIZED:

DATE                                                       January 7, 2011              EMPLOYEE NAME                                                                        Leticia Torres


DIRECT SUPERVISOR                                          David Prenovost              PEOPLE-SOFT EMPLOYEE ID NUMBER                                                        123456789


FOUNDATION PROJECT NUMBER                                         009999                    AY FACULTY                     12-MONTH EMPLOYEE                     OTHER APPT TYPE X 10-month staff



NAME OF PROJECT                                 Very Important Grant Project            ACADEMIC QUARTER                                                                       Fall 2010

                                                0202 - Individual and Project
FIRMS PROGRAM CODE                                        Research                      NUMBER OF WTU'S ASSIGNED DURING QUARTER                                                    8


PREPARED BY                                                   Tiffany Shoup             PERCENT OF TIME TO BE REIMBURSED FROM GRANT                                             26.67%
                                                                  Signature


                                                                                        PERCENT OF TIME TO BE COLLEGE/DEPT COST SHARE                                           26.67%


EMPLOYEE                                                      Leticia Torres            EST REIMBURSEMENT TOTAL FOR QUARTER                                       $5,334.00                    $1,225.00
                                                                  Signature                                                                                         Salary                       Benefits



                                                                                        PEOPLE-SOFT EMPLOYEE POSITION NUMBER                                                  00001234
MGR/GRANTS AND CONTRACTS                                    Debbie Linthicum
                                                                  Signature             UNIVERSITY REIMBURSEMENT CHARTFIELD STRING                           ACCT-UF001-DEPTID-PROGRAM-CLASS

SECTION B: (TO BE SIGNED & SUBMITTED AFTER THE QUARTER ENDS)                                                                                   UNIVERSITY USE ONLY
                                                                                                                                                 BILLING REQUEST
DISTRIBUTION OF EFFORT:                                                 ACADEMIC           PERCENTAGE                         TOTAL                                TOTAL                     REIMBURSEMENT
                                                                        QUARTER              WORKED                           SALARY                              BENEFITS                       TOTAL
PERCENTAGE OF EFFORT:                                                                                                      Total to be Reimbursed to the Univ from the Foundation Account for Period

A.      GRANT REIMBURSED AMOUNT :

                               009999                                  Fall 2010                 26.67%
     Project Number                                                       Quarter

B.      COST SHARING:

                               009999                                  Fall 2010                 26.67%
     Project Number                                                       Quarter


C. OTHER GRANT RELATED ACTIVITY (TO BE SUBMITTED ON A SECOND FORM)

                               001000                                  Fall 2010                 13.33%
     Project Number                                                       Quarter



D.     NON-GRANT UNIVERSITY ASSIGNMENTS (TEACHING/ADMINISTRATION/OTHER):

              Teaching/Administration                                  Fall 2010                 33.34%
     Type of Assignment                                                   Quarter
                                                                                                                                         TOTAL CALCULATED BY UNIVERSITY BUDGET

                                            TOTAL        (MUST EQUAL 100%)                      100.00%
                                                                                                               $                                         $                               $


CERTIFICATION OF EFFORT:
I HEREBY CERTIFY THAT THE PERCENTAGE OF TIME INDICATED ABOVE REPRESENTS THE ACTUAL DISTRIBUTION OF EFFORT I WORKED DURING THE PERIOD SPECIFIED ON THIS REPORT; THAT THE
WORKLOAD SPECIFIED FOR THE GRANT PROJECT IS THE ACTUAL PERCENTAGE OF TIME WORKED ON THE PROJECT; AND THAT THIS DISTRIBTUION OF EFFORT DIRECTLY BENEFITTED THE PROJECT.




EMPLOYEE
                                            Employee                                                                             Date




I HEREBY CERTIFY THAT I HAD FIRST-HAND KNOWLEDGE OF ALL WORKED PERFORMED BY THIS EMPLOYEE AND THAT THE DISTRIBUTION OF EFFORT INDICATED ABOVE REPRESENTS THE ACTUAL
WORK PERFORMED DURING THE PERIOD COVERED BY THIS REPORT.




DIRECT SUPERVISOR
                                            Supervisor                                                                           Date




COLLEGE DEAN/VICE PRESIDENT
(If not direct supervisor, othervise N/A)   Dean/Vice President                                                                  Date




FOUNDATION ACCOUNTING                                                                                                    UNIVERSITY BUDGET
                                            Signature                                           Date                                                 Signature                                     Date
                                                                                                                                                                                                            Rev. 06/10
                                    Cal Poly Pomona Foundation, Inc.
                                      “Quality Service Supporting Quality Education”

                                         Office of Grants and Contracts
                                   Grants and Contracts/Foundation Program Funds
                                    Appointment Authorization/Effort Certification

Form Instructions:

SECTION A: (Completed at the Beginning of Each Academic Quarter)

Date:                                           Date in which the form is being completed by Dean’s Office.

Direct Supervisor                               Indicate the direct supervisor who has first hand knowledge of
                                                employee's work.

Foundation Project Number:                      Indicate Foundation account number from which source funds
                                                for faculty release time will be reimbursed.

Name of Project:                                Indicate the name of the project

Employee Signature                              Employee must sign the form

Prepared By Signature:                          Person preparing the form must sign the form.

FIRMS Program Code:                             Indicate the University FIRMS program code relating to this project.

Employee Name:                                  University Faculty/Staff member who will receive release
                                                time to work on a Foundation project.

Number of Months of Employment:                 Please check the box indicating the number of months this employee
                                                works for the University. If it is other than 9 months, please indicate the
                                                number of months on the the other line.

People-Soft Employee Number:                    People-soft employee number of the employee referred to above.

Academic Quarter                                Indicate the academic quarter in which the employees is being reassigned
                                                (Do not indicate more than one academic quarter)

Number of WTU's Reassigned During Academic For Faculty employees, indicate the number of units worked
Quarter                                    during the quarter. NOTE: A full-time load for most faculty employees
                                           represent 12 teaching units (WTUs) and 3 WTUs of service/committee work for
                                           a total of 15 units. The number of WTU for the employee should
                                           be the same as the University's Peoplesoft system as the record of the
                                           amount of WTU's worked during quarter for the employee.

Percent of Time to be Reimbursed from Grant Indicate the percentage the University faculty/staff member
                                            has been released to work on the Foundation project.
                                            PLEASE DO NOT ROUND
                                            Example: 4 WTU/15 WTU is 26.67%

Percent of Time to be Cost Shared by College: Indicate the percentage the University faculty/staff member
                                              has been released to work on the Foundation project that
                                              will be matched by the College. PLEASE DO NOT ROUND
                                              Example: 4 WTU/15 WTU is 26.67%

Estimated Reimbursable Salary Total             Calculate by multiplying the percent of time work on grant and the
                                                University monthly salary projected for the period multiplied
                                                by the number of months faculty/staff member will work on the project.
                                                Remember, if you are asking for reimbursement for a 10 month faculty employee,
                                                calculate the reimbursable total amount based on 4 months of work.

Estimated Reimbursable Benefit Total            Calculate by multiplying the percent of time work on grant and the
                                                University monthly benefits projected for the period multiplied
                                                by the number of months faculty/staff member will work on the project.
                                                Remember, if you are asking for reimbursement for a 10 month faculty employee,
                                                calculate the reimbursable total amount based on 4 months of work.

University Reimbursement Account Number         Complete the University account number in which reimbursed funds
                                                will be deposited into. Must start with UF001.

PROCESS FOR SECTION A AT THE BEGINNING OF EVERY ACADEMIC QUARTER:

After the information has been completed in Section A of this form, it must be submitted to Foundation Grants
and Contract Department for submitted to University Budget Services. This form must be completed and submitted
at the beginning of the academic quarter.
                                     Cal Poly Pomona Foundation, Inc.
                                       “Quality Service Supporting Quality Education”

                                          Office of Grants and Contracts
                                    Grants and Contracts/Foundation Program Funds
                                     Appointment Authorization/Effort Certification


SECTION B: (Completed at the End of Each Academic Quarter)

Percentage Worked on Project:

A. Grant Reimbursed Amount:                      Complete the grant number, month, and the percentage of time worked on the grant project
                                                 which will be reimbursed back to the Academic Unit. This percentage must be
                                                 the same as Section A above.
                                                 Example:              009999     Fall 2010             26.67%

B. Cost Sharing                                  If cost sharing is a requirement of the award, complete the month
                                                 and the percentage time worked on the project which will not be
                                                 reimbursed to the college.
                                                 Example:                 009999    Fall 2010              26.67%

C. Other Grant Related Activity (To Be Submitted on a Second Form)
                                              If the University employee has worked/is working on another
                                              grant account(s), indicate the percentage of time worked on this project.
                                              The percentages indicated on this section will require a second
                                              Effort Certification form in order to be reimbursed back to the College.
                                              Example:                 001000     Fall 2010                5.00%

D. Non-Grant University Assignments (Teaching/Administration/Other)
                                            Indicate the percent of non-grant activity the individual worked during the
                                            period specified on the form. This percentage would represent
                                            teaching assignments, committee work, and administrative tasks.
                                            Example:               Teaching Fall 2010                  41.66%

VERIFY THAT THE TOTAL FOR EACH PERIOD MUST EQUAL 100 PERCENT EFFORT. FORMS
WHICH DO NOT EQUAL 100 PERCENT WILL BE RETURNED.

Certification of Effort:                         The employee and their direct supervisor must sign and date
                                                 the form. If the direct supervisor is not the Dean/Vice President,
                                                 the Dean/Vice President responsible for the Academic
                                                 Unit must sign the form as well.

PROCESS FOR SECTION B AT THE END OF EVERY ACADEMIC QUARTER

This form must be completed on a quarterly basis and submitted to the Office of Grants and Contracts
After it has been reviewed by the Office of Grants and Contracts, it will be forwarded
to University Budget and University Accounting for preparation of an invoice and subsequent reimbursement
to the College for the salary payments made during the quarter. Please note, the long-term success of
these new procedures is dependent on the prompt submission of the Distribution of Effort portion of
the form by the employees/principal investigators working on these projects. When the Distribution of
Effort portion has been submitted, the invoice will be generated by University Accounting and the
actual payment will be recorded to the grant account and paid to the University. This
will be done on a quarterly basis only after the Distribution of Effort portion has been completed
and submitted to Foundation Grants and Contracts.

If you have any questions, please call Debbie Linthicum x2961.

								
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