Fill in all the required fields.  Failure to complete a required field will prevent you from submitting the form.  Please include any additional useful information in the Comments field.

“ * ” Indicates a required field

Comments:

Requestor Information

* Requestor’s Name:
(Only someone with an active UT appointment may request a cash advance.)

* Requestor's EID:

* Requestor’s Email:

Contact Phone Number:

* Faculty Name:

Advance Information

* Account (Ten numbers, no dashes):

* Amount of Advance (Must be greater than $100):

* Date check is needed (Must allow 9-10 days’ notice):

* Time period requested:
(Should not be more than 3 or 4 months’ time. Signatures and any remaining money will need to be turned in to your Account Manager before this date.)

* Name of study [abbreviate title]:

Check all that apply:

* I am authorized to request an advance on this account.

* I have read and understand the policy and procedures regarding cash advance requests in the PsychologyDepartment.