________________________
THE STATE UNIVERSITY OF NEW JERSEY

RUTGERS

Division of Grant and Contract Accounting
3 Rutgers Plaza
New Brunswick, NJ 08901

REQUEST TO ESTABLISH A NON-BUDGETARY ACCOUNT NUMBER INFORMATION SHEET
Requestor:

Responsible Person            _______________________________
College or Unit                   _______________________________
Responsible Department     _______________________________
Extension                           _______________________________
RIAS Organiszation Code  _______________________________
EBRC   _______________________________________________

Recommended Title:

Describe Purpose:    (attach additional pages if needed)



Source of Income:



Estimated Annual Income:



Type of Expenditures to be incurred:



Will this account be used to support any other existing sponsored research contract or grant project? If yes, please describe:




Will this account be used for appointment of personnel including consultant fees? If yes, please describe:




Conditions:

1. I understand that expenditures of this account shall not exceed the cash available balance.
2. I understand that this account shall not be used for sponsored research contracts or grants
    for specific work or services.
3. In the event account is overdrawn you may transfer funds from account number (can not be a
    4-2XXXX account number)
_________________entitled________________________________________







Approvals:                                Signature                                      Date

Department Head/Chair   ____________________________   ___________
Dean or Director             ____________________________    ___________
Provost (if required)        ____________________________    ___________
Business Office               ____________________________    ___________

Persons who will be authorized to receive and expend from this account:
Name                                                            Phone Extension
_________________________________   _______________
_________________________________  _______________


Requestor Certification:

               I certify that the information disclosed above is true and correct.

               _________________________________  _______________
                                Name of Requestor                              Date

Copies: Responsible Person
            Department Head/Chair
            Dean
            Business Representative
___________________________________________________________________________

Send completed form to DGCA

TO BE USED BY DGCA

Account#                                Account Title:
Accountant Code:
Responsible Person:
Department/College:
A-21 Code:
update 1-15-2008