Forms

Forms by Department

• Main Office

  Insurance Claim-Injury/Damages (Employee) 

  Insurance Claim-Injury/Damages (Non-Employee)

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  201 Burgin Dossett Hall, PO Box 70601, Contact Us, (423) 439-5884, vpfa@etsu.edu

• Budget

  • Budget Revision

    When do I need to use a budget revision form? 
    Budget revision forms are to be completed by the budgetary unit when a change to the base budget is requested. Budget revisions are administered when funds are needed to cover pending expenditures, to cover overdrafts or to transfer funds for other departmental uses. Permanent budget adjustments effect more than one fiscal year while temporary budget adjustments only effect the current fiscal year.
     
    What cannot be processed on a budget revision form?
    Budget revisions CANNOT be processed between Funds. This means to/from General Academic Campus to/from College of Medicine, Family Medicine, College of Pharmacy, Grants, Foundation, Agencies and Auxiliaries. If a budget revision is needed for a grant index (six-digit index number), please contact Grant Accounting in Financial Services.
     
    How will I know the budget revision has been processed?
    Once approved by the Office of Budget and Financial Planning, the budget revision is entered into Banner and a copy of the processed budget revision form is forwarded to the originating department. A copy of the budget revision form is maintained in the Office of Budget and Financial Planning and Financial Services. The department can also verify the budget revision has been processed by GoldLink.

    Budget Revision

  • New Position Request

    New Position Request
    

  • Sample Budget Revision & Instructions for Preparing Revision: Paper & Online

    Sample Budget Revision & Instructions for Preparing Revision: Paper & Online

    How do I complete a paper budget revision form?

    1. Request for Budget Revision for Fiscal Year – Enter the Fiscal Year for the budget revision to be processed.
    2. Permanent or Temporary – Check the appropriate box. Check Permanent if the budget adjustment effects more than one fiscal year. Check Temporary if the budget adjustment is just for the current fiscal year.
    3. Index Number – The five digit number assigned to an index (i.e. 40400 for Budget and Financial Planning.)
    4. Account Code - The five digit number identifying where the budget is being transferred to or from (i.e. Travel 73000, Operating 74000, etc.)
    5. Index Name – The name of the index that corresponds with the five digit index number. (Organizational name). For the official index name, go to ePrint report FGRACCI, Account Index Report.
    6. Amount Increase – The budget dollar amount rounded to the nearest $10 to be added to the corresponding account code.
    7. Amount Decrease – The budget dollar amount rounded to the nearest $10 to be subtracted from the corresponding account code. Make sure that the amount increase column equals the amount decrease column.
    8. Justification – A short explanation as to why the funds are being transferred.
    9. Requested by – The name of the originator from the budgetary unit who can be contacted if any questions arise.
    10. Approved by – Approval by the appropriate Chair/Dean/Director or his designee.
    11. Approved by – Approved by the appropriate Vice President for the division, President or designee.
    12. Approve by – Approval by the Associate Vice President for Budget and Financial Planning or designee.
    13. Budget Office Use Only – (Information in the upper left hand corner). Upon final approval, the Office of Budget and Financial Planning will assign a Batch Header number (BDXXXXXX). This information identifies the specific batch of budget revisions processed for that effective date.

    How do I complete an online budget revision form? 

    1. Request for Budget Revision for Fiscal Year – REQUIRED - Enter the Fiscal Year for the budget revision to be processed.
    2. Type:  Permanent or Temporary – REQUIRED - Check the appropriate box.  Check Permanent if the budget adjustment effects more than one fiscal year.  Check Temporary if the budget adjustment is for the current fiscal year only.
    3. Justification – REQUIRED - A short explanation as to why the fund transfer is being requested.  Supporting documentation can be uploaded, i.e.  Fiscal Year Salary Allocation Form.
    4. Index Number – REQUIRED - The five digit number assigned to an index (i.e. 40400 for Budget and Financial Planning.
    5. Account Code – REQUIRED - The five digit number identifying where the budget is being transferred to or from (i.e. Travel 73000, Operating 74000, etc.)
    6. Index Name – REQUIRED - The name of the index that corresponds with the five digit index number.  (Department name not the name of the account code).
    7. Amount Increase – The budget dollar amount rounded to the nearest $10 to be added to the corresponding account code.
    8. Amount Decrease – The budget dollar amount rounded to the nearest $10 to be subtracted from the corresponding account code.
    9. Total – MAKE SURE THAT THE AMOUNT INCREASE COLUMN EQUALS THE AMOUNT DECREASE COLUMN.
    10. Signatures – Business Managers will be responsible to establish the approvers for each of their units.
        1. Department Signature – Originator of the budget revision.
        2. Chair Signature – Approval by appropriate Chair of Department or designee for Academic Units.
        3. Dean/Director – Approval by appropriate Dean/Director or designee.
        4. President/Vice President – Approval by the appropriate Vice President for the division, President or designee.
        5. Note: Rejected budget revisions can be sent back to the Originator for corrections or further clarifications.
    11. Comments – Additional information by approving party.  Especially important when the budget revision is being rejected and returned.
    12. Budget Analyst – Notification that the budget revision (BR) has been received by the Office of Budget and Financial Planning.  The BR will be reviewed for final approval.  The BR will be entered into the Banner system manually.  A copy of the processed BR will be e-mailed back to the Business Manager and/or Orginator.
    13. Budget Office Use Only – (top of form) – Upon final approval, the Office of Budget and Financial Planning will assign a Batch Header Number (BDXXXXXX).  This information identifies the specific batch of budget revisions processed for that effective date.
    14. Note:  Paper copies will continue to be accepted.

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  203 Burgin Dossett Hall, PO Box 70562, Contact Us, (423) 439-4383, weise@etsu.edu

• Financial Systems & Tech

   

  • Goldlink Finance/ePrint & eBucs Requisitioning and/or Approvals

    Create Access for a New User or Establish Additional Access for Current Users

    • Used by departmental staff who monitor budget information via Goldlink Finance Self-Service or ePrint Finance reports.
    • Used by departmental staff who place and/or approve requisitions/purchase orders in eBucs.
    • Must be filled out and submitted by the employee requesting access or by the employee's Supervisor, which is determined by the employee's Timekeeper in TRS. If an employee's Supervisor is changed by the Timekeeper, a new form will need to be submitted.
    • Will automatically reoute for Supervisor approval. Additional approvals will be obtained by Financial Systems and Technology as needed, including the Financial Manager(s) and Campus Business Manager.
    • Submissions will be rejected if no additional access will be established.
    • For urgent needs, please add only the index or organization needed to a submission of this form. All other indexes and organizations needed should all be added to a single submission rather than listing one index or organization on multiple separate submissions.
    • Access cannot be established based on comments, indexes/organizations must be added row by row. If an index/organization will not populate into a row, please make a note regarding the error in the comments field and list the index/organization, including chart E or chart F, and the corresponding access that is needed in eBucs (Requisitioning and/or Approval access).
    • eBucs Approval Access is prohibited for Clerical/Support staff in the College of Arts and Sciences and for all Clerical/Support staff for all Chart F (Foundation) indexes/organizations.
    • eBucs Approval Access must be requested by the index and cannot be established on organizations.
    • Goldlink Finance/ePrint access is requested by default as a user must have this access in order to establish the respective access in eBucs.
    • If the same account is listed as an index and as an organization, there is no need to add them both to the form, simply add the index to the form as access to the organization will be established automatically.

    Remove all Access or Remove Specific Access for a Single User

    • NOT required or applicable for terminations.
    • Typically used when an employee's duties/responsibilities are reduced, such as when an employee transfers to another position or when a Department Chair steps down.
    • May be filled out and submitted by any ETSU employee and any user may be added to the form.
    • Will by reouted automatically for approval from the Supervisor of the Employee who will have access removed, this Employee will be notified at the end of this process.
    • Comments regarding any access to be retained are encouraged.

    Remove All Access or Remove Specific Access for Multiple Users

    • NOT required or applicable for terminations.
    • Typically used when an employee's duties/responsibilities are reduced, such as when an employee transfers to another position or when a Department Chair steps down.
    • May be filled out and submitted by any ETSU employee and any user(s) may be added to the form.
    • Will by reouted by Financial Systems and Technology for Employee(s) and Supervisor(s) approval. Additional approval may be obtained as needed from Campus Business Manager(s).
    • Comments regarding any access to be retained are encouraged.
  • TouchNet

    TouchNet Cashiering/Business Office - Establish Access (Web Departmental Deposits)

    • Who should I contact for assistance?
       sealerd@etsu.edu

    TouchNet Marketplace - New Online Payment Site/Product/TouchNet Ready Partner

    • Who should I contact for assistance?
      Accounting Needs (Indexes Required by Forms) - Karen Glover, gloverk@etsu.edu
    • All Other Needs - sealerd@etsu.edu

    TouchNet Marketplace - Order Refund (uStore/uPay/TouchNet Ready Partner)

    • Who should I contact for assistance?
      sealerd@etsu.edu

    TouchNet Marketplace - Multiple Orders Refund (uStore/uPay/TouchNet Ready Partner)

    • Who should I contact for assistance?
       sealerd@etsu.edu

    TouchNet Marketplace - Order Cancellation (uStore)

    • Who should I contact for assistance?
       sealerd@etsu.edu

  Vendors/Individual Payees/Reimbursees, Please Visit: Non-Employee Direct Deposit

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  202 Burgin Dossett Hall, PO Box 70601, Contact Us, (423) 439-5504

• Foundation Accounting

  Foundation Deposit Transmittal

  Fundraising - Solicitation & Acceptance

  Scholarship Authorization 

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  302 Burgin Dossett Hall, PO Box 70601, Contact Us, (423) 439-4702, etsufdnacctg@etsu.edu

• Financial Services

  Authorization of Signature
  

  Authorization of Signature-Agency Account

  Records - Disposal Authorization & Classification Guide

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  201 Burgin Dossett Hall, PO Box 70732, Contact Us, (423) 439-6110, mcbee@etsu.edu

• Accounts Payable (Travel)

  Main Forms:
  

  Food/Business Meal & Recognition Event Payment

  Procard Enrollment

  Reimbursement or Check Request

  Travel Forms:

  Charter Flight Request

  Exception Travel Advance

  Registration Fee Prepayment

  Travel Authorization

  Travel Claim

  Travel Claim Mileage

  Travel Claim Team/Group

  Travel Rates

  Vendors/Individual Payees/Reimbursees, Please Visit: Non-Employee Direct Deposit

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  B016 Burgin Dossett Hall, PO Box 70729, Contact Us, (423) 439-6112, etsuap@etsu.edu

• Financial Accounting

  • New Agency Fund

    New Agency Fund

    • Agency fund index numbers are mostly used for student clubs
    • Use of agency funds must follow the policies and guidelines posted by Student Activities and Organizations https://www.etsu.edu/students/sao/policiesforms.php
    • Financial manager must be an employee of the university
    • A balance must be available before any disbursements can be made
    • A university index is required for the department that will be responsible for any over spending on the agency fund
    • Disbursements and other transactions will follow all university policies
  • New Detail Code

    New Detail Code

    • This is used to request a new detail code to post to students’ accounts
    • This usually accompanies a form for New Org/Index or New Agency Fund
  • New Organization/Index

    New Organization/Index

    • This form is used to request a new index code for a new expense or new revenue index or to request a new organization code
    • New index codes can be requested on existing organization codes
    • The financial manager should be the person that will be listed on the index code as the responsible financial manager.

    Return the form
  • Wire Transfer - Domestic

    Wire Transfer - Domestic

    • This form is used to request payments to international recipients
    • Purchases of goods and services must still follow all procurement policies
    • ETSU incurs a charge of $25 from our bank for the processing of each domestic wire transfer. The requesting party assumes responsibility for this fee and acknowledges that the charge is passed to the index to be provided below. With the submission of this form, you are agreeing to transfer of a $25 fee as well as the total dollar amount of the wire to the indexes to be provided below. If the Payee listed below attempts to name an intermediary bank, the bank must be a Standard Chartered Bank. All wire transfers initiated by ETSU will process in US dollars.
  • Wire Transfer - International

    Wire Transfer - International

    • This form is used to request payments to international recipients
    • Purchases of goods and services must still follow all procurement policies
    • ETSU incurs a charge of $55 from the bank for the processing of each international wire transfer. The requesting party assumes responsibility for this fee and acknowledges that the charge is passed to the index to be provided on this form. With the submission of this form, you are agreeing to transfer of a $55 fee as well as the total dollar amount of the wire to the indexes to be provided below. If the Payee listed below attempts to name an intermediary bank, the bank must be a Standard Chartered Bank. All wire transfers initiated by ETSU will process in US dollars, at the current exchange rate as of the time the request is initiated by our bank
  • Wire Transfer - International (International Student and Scholar Services)

    Wire Transfer - International (International Student and Scholar Services)

    • This form is to be used only for the Office of International Programs for payment of study abroad courses

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  202 Burgin Dossett Hall, PO Box 70732, Contact Us, (423) 439-4316, accounting@etsu.edu

   

• Grant Accounting

  Cash Payment Acknowledgment Receipt
  This form is used to acknowledge cash received in payment for participation in a research study.

  Cash Payment Research Participants
  
  This form is used to request petty cash for payments to research participants.

  Cost Transfer

  Cost Waiver
  This form is used to request a cost waiver, an indirect cost reduction, or a tuition waiver. 

  Exception PI Eligibility
  This form is used to request an exception to the principal investigator eligibility policy.

  Fiscal Year Salary Allocation

  Fiscal Year Salary Allocation - Instructions

  These instructions will help in filling out the Fiscal Year Salary Allocation form (FYSA) which is used to reallocate payroll charges.

  Any retroactive fiscal year salary allocation beyond the one-month period will require a service charge of $500.00. For academic units, the charge will be to the dean's account of the respective college for each change of status.  For non-academic units, the Vice President or President will determine the appropriate account to be charged.  Exceptions to the charging for retroactive change of status beyond the one-month period will require the approval of the Comptroller.        

  Cell phone change requires a new cell phone allowance form.

  Grant Internal Routing
  This form is used to provide information and acquire approvals on new grant proposals or contracts.

  Grant Program Payment
  This form is used to request payment of tuition and fees for students from grants.

  No Cost Extension
  This form is used to request a no-cost extension of a grant.

  Pre Award Sponsored Account
  This form is used to request a pre-award grant number.

  Re-Budget
  This form is used to request a re-budget of your grant.

  Subaward Payment Authorization
  This form is used to request payment of a subrecipient invoice.

  Traditional Gift Card Acknowledgment
    This form is used to provide acknowledgement of receiving a gift card by grant research participants.

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  202 Burgin Dossett Hall, PO Box 70732, Contact Us, (423) 439-4275, granttmp@etsu.edu

• Payroll

  >403(b) Deferral Change

  Cell Phone Allowance

  Direct Deposit Authorization-Payroll (PDF)

  Direct Deposit Authorization-Payroll (Dynamic Forms)

  Employee Award Payment

  Extra Compensation

  Payroll Deduction-Food Service Employee Block Plan

  Payroll Deduction-Foundation

  Time Report

  TN State Retirement - Higher Education (TCRS/ORP, 401K/457)

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  311 Burgin Dossett Hall, PO Box 70732, Contact Us, (423) 439-5320, payroll@etsu.edu

• Tax and Revenue Services

  Certificate of Sales Tax Exemption for Supplier

  Taxable Fringe Benefit - Reporting

  Taxable Fringe Benefit - Request for Extra Compensation

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  202 Burgin Dossett Hall, PO Box 70713, Contact Us, (423) 439-5869, beavermg@etsu.edu

• Bursar (Benefits/Loans)

  Main Forms:

  Contract Voucher

  Departmental Receipting Deposit General

  Invoice Request

  Student Refund Appeal

  Things You Should Know When Withdrawing

  Educational Benefit Forms:

  Fee Discount (Children Public School Teachers/State Employees)

  Fee Discount (Spouse/Dependent of ETSU Employees)

  Fee Waiver, Non-Credit and/or Audit (ETSU Employees)

  Public Higher Education Fee Waiver (State Employees)

  Tuition Reimbursement (ETSU Employees)

  A new Request for Education Benefits dynamic form will go-live on 7/15/2022. All requests for Fall 2022 (Fee Waivers, Tuition Reimbursements & Spouse/Dependent Discounts) will need to be submitted via the new electronic form. Paper/PDF forms will continue to be accepted for only Summer 2022. Please visit the Human Resources website for more information.

  Loan Forms:

  College of Medicine, Resident Emergency Fund

  E.G. Hughes, Emergency Event

  E.G. Hughes, Enrollment

  E.G. Hughes/University-Kick Start

  Perkins Disbursement/Perkins Hardship Deferment/Forbearance Postponement

  Student Deferment

  ETSU Education Abroad Bridge Loan Application

  University Short-Term (*Loan Funding Currently Unavailable*)

  University Sponsored Enroll. Kick Start, Short Term/Emergency

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  202 Burgin Dossett Hall, PO Box 70719, Contact Us, (423) 439-4212, bursar@etsu.edu

• Central Receiving

  Alcohol Order

  Copy Paper Order

  Equipment Inventory Change/Deletion Request

  Missing Equipment

  Participate in PASTA

  Shipping Label

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  325 Treasure Lane, PO Box 70696, Contact Us, (423) 439-4364, simmons@etsu.edu

• Contract Services

  Agreement Routing

  Agreement Routing College Medicine & Family Medicine

  Amendment to Contract

  Clinical Affiliation Agreement

  Dual Services Agreement

  Employee vs. Independent Contractor Classification Criteria

  HIPAA Business Associate Agreement

  Payment Personal Services Less Than $5,000

  Preceptor Agreement

  Standard Contract

  Standard Contract Terms & Conditions

  Use of Campus Facilities Agreement

  W-8BEN, Foreign Individual-Certificate Foreign Status

  W-9, U.S. Citizen-Taxpayer Identification

  Fiscal Review Committee:

  Checklist

  Non-Competitive Contract

  Non-Competitive Contract Amendment

  Summary Sheet

  Supplemental Department Information

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  202 Burgin Dossett Hall, PO Box 70713, Contact Us, (423) 439-6888, mitchellbg@etsu.edu

• Purchasing

  Amendment to Contract

  Pro Forma Contract

  Purchasing a Department/University Owned Vehicle

  RFP Template

  RFQ Template

  Service and Software Accessibility Standards

  Sole Source Justification

  Sole Source and Proprietary Definitions

  Vendors/Individual Payees/Reimbursees, Please Visit:  Non-Employee Direct Deposit

  Goldlink Finance/ePrint & eBucs Access, please visit:  Financial Systems & Technology

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  B016 Burgin Dossett Hall, PO Box 70729, Contact Us, (423) 439-4224, hernandezs3@etsu.edu 

• Auxiliaries/Nonres. Tax

  Nonresident Alien Tax Compliance-Schedule Appointment

   

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  202 Burgin Dossett Hall, PO Box 70713, Contact Us, (423) 439-6887, criggerj@etsu.edu

• Post Office

  • Department Stamp/Envelope/Letterhead Request

    Department Stamp/Envelope/Letterhead Request

    When should I use this form?
    Use this request when departments need books of stamps for official school usage or to order pre-printed envelopes or department letterhead.

    Who should I contact with questions?

    • Questions concerning stamp ordering can be sent to postal@etsu.edu or call 439-4232.
    • Questions concerning Envelope/Letterhead can be sent to postal@etsu.edu or call 439-6894.

    Who should I contact for technical access assistance?
    Ryan Seale: via MS Teams or sealerd@etsu.edu

  • Request for New ETSU Department Mailing Address

    Request for New ETSU Department Mailing Address

    When should I use this form?
    Use this form when a new department is being formed and needs a new ETSU Mailing Address.
    
    Who needs to approve this form?
    The form must be routed to the Dean or Department VP for Approval.

    How will I know when my new address is ready?
    Once reviewed and approved by Postal Services, the requestor will be informed of the new address and date it can be used.

    Are there any restrictions?

    • All ETSU Departments must use the PO Box assigned.
    • Street addresses are optional but if used, it must be placed above the PO Box address.

    Who should I contact with questions?
    Questions regarding completing the form should be sent to postal@etsu.edu

    Who should I contact for technical access assistance?
    Ryan Seale: via MS Teams or sealerd@etsu.edu

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  110 D.P. Culp University Center, PO Box 70267, Contact Us, (423) 439-4232, postal@etsu.edu

• Passport Services

  Request for New ETSU Department Mailing Address

  DS-3053=Statement Consent, Issue to Minor < 16

  DS-5504=Apply for Name Change/Data Correction/Limited Replacement

  DS-5525=Statement Exigent/Special Family Circumstances, Issue to Minor < 16

  DS-64=Report valid U.S. Passport lost/stolen

  DS-82=Renewing Adult U.S. Passport

  DS-86=Statement of Non-Receipt of a U.S. Passport

  STEP=Safe Traveler Enrollment Program

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  147 D.P. Culp University Center, PO Box 70267, Contact Us, (423) 439-7277, postal@etsu.edu