1.        
    1. P-CARD ACTION FORM
      1.        
    2.        Today’s Date: 
      1. Cardholder’s orApprover’s Name:
      2. P-Card Account #:
      3. Supervisor/Budget Head Name:
      4.         
      5. The Employee above: (Check One)
      6.  NEW DEPARTMENT:
      7.  NEW DEPARTMENT MAILING ADDRESS & PHONE:
      8.  CHANGED JOB RESPONSIBILITIES. CANCEL CARD PRIVILEGES.
      9.  IS NO LONGER AN EMPLOYEE. CANCEL CARD PRIVILEGES.
      10.  DATE OF TERMINATION:
      11.  IS ON EXTENDED LEAVE FOR MORE THAN 30 DAYS**.
      12.  ACTION WHILE     MAINTAIN CARD PRIVILEGES
      13. ON LEAVE:  
      14.         SUSPEND CARD PRIVILEGES



       



P-CARD ACTION FORM



             



             Today’s Date:  

 



Cardholder’s or
Approver’s Name:

Check one:     Cardholder   Approver



P-Card Account #:



Supervisor/Budget Head Name:
 



               



The Employee above: (Check One)


 CHANGED DEPARTMENTS*. MAINTAIN CARD PRIVILEGES FOR NEW DEPARTMENT:
 * Note: This box is generally applicable to Cardholders ONLY.


NEW DEPARTMENT:

 



NEW DEPARTMENT MAILING ADDRESS & PHONE:

 
 
 




 CHANGED JOB RESPONSIBILITIES. CANCEL CARD PRIVILEGES.
 




 IS NO LONGER AN EMPLOYEE. CANCEL CARD PRIVILEGES.



DATE OF TERMINATION:



 IS ON EXTENDED LEAVE FOR MORE THAN 30 DAYS**.
 




 ACTION WHILE          MAINTAIN CARD PRIVILEGES



ON LEAVE: 



               SUSPEND CARD PRIVILEGES


               CANCEL CARD PRIVILEGES

 **Note: If Approver is no longer an employee of the College, is leaving the College, or changing job responsibilities, respective cardholder cannot use the card until new approver is assigned.
 
 
APPROVED BY:________________________________________ DATE:___________________________         Supervisor/Budget Head
 
APPROVED BY:________________________________________ DATE:___________________________

 
Budget Head (if Supervisor is not also Budget head)

 
APPROVED BY:________________________________________ DATE:___________________________
      Appropriate Vice Chancellor
 
DATE ACTION TAKEN: ___________________________________ DATE: ______________________
        Program Administrator Signature     
COMMENTS:
 

Form 3300/013 (8/18)
 

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