The University of Memphis

Effort Re-Certification

Submit Completed Form to the Accounting Office/Grants & Contracts Accounting
Administration Bldg., Room 275
Date:     Banner U Number:

Provide a detailed explanation for the need of the salary adjustment and subsequent recertification of salary charges in a previously certified effort period. Attach the original effort form with changes indicated. All changes must be initialed.

Employee Name		  
________________________________________________
Signature		 _________________________
Date
By signing above, the Employee certifies the effort changes indicated on the attached Effort Certification form are appropriate for the sponsored project.
APPROVALS

Principal Investigator Name
Department Chair Name
________________________________________________
SignatureDate		 ________________________________________________
SignatureDate

Dean Name		  
________________________________________________
SignatureDate		  
The University of Memphis, one of the Tennessee Board of Regents institutions, is an Equal Opportunity/Affirmative Action University.