Winona State University

Long Range Planning And Assessment Committee

Request for Approval to Incur Special Expenses

*** Must be received by January 16, 2009***

Name and Title of Requestor__________________ Agency / Department Name:____________________

Phone:__________________ Date:___________________

Approval is requested for the following

___ meals within work area

___ refreshments

Full name of conference: Assessment Day Activities Dates and time of event: February 17, 2009.

Location of event:_________________________

Describe why state should pay these expenses: These funds will be used on a one time basis to provide refreshments to students and faculty to further the university's assessment initiative.

Itemization of costs: description / quantity / unit cost / total

Name of Sponsor: Office of Assessment and Institutional Research

TOTAL REQUESTED FOR APPROVAL:

For whom is approval of special expense being requested?

NOTE: a completed 1400 form must accompany this request.

Department approvals

___________________________ chairperson / director

___________________________ assessment coordinator (not to exceed:___________)

Not approved because:

Submit this form, the completed 1400 form, and the Assessment Day Funding Request to the Assessment Office (SLC TERRACE) by Januray 17, 2009.

return to Challenge Grant Page