Use this guide to help you fill out the Policy Template
Policy Number
A unique identifier that will be assigned by the policy coordinator.
Title
Title of the policy. Succinct description of the proposed policy.
Effective
Effective Date of the policy.
Example:
MM/DD/YYYY.
Senate Proposal
No/Yes. Indicates whether or not the policy originated from a University Senate proposal. If yes, the policy requires Senate approval for changes to the policy. If no, the policy is in the control of the Responsible Office.
Responsible University Officer
Title of the University officer (provost, vice president office) responsible for implementing the policy and ensuring necessary procedures and guidelines are developed.
Responsible Office
Name of University office with responsibility of implementation of the policy. This office also had control of the changes that are made to the policy in the future.
Policy Statement
A well-articulated, authoritative expression of philosophy and direction. Does not change frequently.
Policy Requirements
Required elements for any procedures supporting the policy.
Purpose
Provide background information for the need and result of the policy.
Scope
Information regarding who is affected by this policy, and which departments or individuals should especially be aware of its contents.
Related Policy Information
Include here any supporting information for this policy.
Exclusions
Exclusions (groups of individuals, funding, etc.) to the policy – if none, it is assumed that the policy applies across the University.
Contacts
Individuals who can be contacted regarding the policy.
Example:
Individual Title and/or Department Name—487-XXXX
Definitions
List unique terms, which by being defined, add to the reader’s understanding of the policy.
Example:
(Word and/or Phrase to Be Defined) – (Define the word and/or phrase to eliminate reader interpretation.)
Responsibilities
Individual areas of responsibility followed by the function to be performed. List all the various employees and/or department’s responsibilities.
Example:
(Title/Department of Responsibility 1) – (State their responsibilities).
Procedures
List of procedures that directly support this policy
Example:
Procedure 11.1.1 Establishing and Creating University Policy.
Forms/Instructions
The forms and associated instructions that are used in direct support of the policy.
Example:
Form: (Form Name)
Instructions: (Title of Instruction)
Appendices
Any lengthy or complex reference information that would disrupt the flow of the other sections.
History
Adopted: mm/dd/yyyy Approved by appropriate executive team member
Revised: mm/dd/yyyy Brief description of changes made.