Office of the Treasurer - Delegation of Signature Authority Request Form

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Delegation of Signature Authority Request Form

Please enter the information pertaining to your request and then click the "Submit Request" button.

(Select One)*

New Request

Change to an Existing Request

Contact Information for Request
First Name:*
Last Name:*
Email:*
Phone:*

New Requests

Name of Proposed Delegate:
Title of Proposed Delegate:
Department :
Effective Date for Proposed Delegation (xx/xx/xx):
Business Justification for Delegation:

Type of Document(s) Proposed for Authorization (Please list separately if more than one)

Name	Description

Changes to Existing Delegations

Name of Proposed Delegate:
Title of Proposed Delegate:
Name of Existing Delegate:
Title of Existing Delegate:
Department:
Effective Date for Delegation Change (xx/xx/xx):
Business Justification for Delegation Change:

Documents To Be Added to Existing Delegation (Please list separately if more than one.)

Name	Description

Documents To Be Removed From Existing Delegation (Please list separately if more than one.)

Name	Description

Note: All requests will be reviewed by the Office of the Treasurer in conjunction with the Office of General Counsel.
If applicable, a standard agreement template will be developed for specific business function.