Change in Organizational Unit

Please allow a two-week minimum turnaround time after submitting form.
Submit form to BFSS, Admin Bldg, Room 151

The University Of Memphis Operating Procedure No. UM1303 provides additional information for completing this form.

I. CHANGE IN ORGANIZATIONAL STRUCTURE

	Unit Name	Organization Number

Level of Organizational Assignment (Available from Program Guide)	Title of the Organization	Organization Numbers
Provost/Vice President:
Vice Provost:
Dean/Director:
Chair/Department Head:
Principal Investigator:
Username:
Banner UID:
Position Number:
Effective Date of Change:

If this change relates to a new institute, center, or bureau, has TBR been notified Yes No. If "Yes," then attach approval/notification to this request. If "No," then refer to TBR Guideline A-040 before submitting this form.

II. CHANGE IN NAME/TITLE OF ORGANIZATIONAL UNIT

	Title of the Organization	Organization Numbers
Old Unit Name:
New Unit Name:
Effective Date of Change:

III. SUBMITTER INFORMATION

Name of Submitter:
Title of Submitter:
Name of Approver:
Title of Approver:
Contact Person:
Contact Person's Phone:

Signature of Submitter __________________________________ Date___________

Signature of Approver ___________________________________ Date___________

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