Use this guide to help you fill out the Policy Template
A unique identifier that will be assigned by the policy coordinator.
Title of the policy. Succinct description of the proposed policy.
Effective Date of the policy.
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.
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.
A well-articulated, authoritative expression of philosophy and direction. Does not change frequently.
Required elements for any procedures supporting the policy.
Provide background information for the need and result of the policy.
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 (groups of individuals, funding, etc.) to the policy – if none, it is assumed that the policy applies across the University.
Individuals who can be contacted regarding the policy.
Individual Title and/or Department Name—487-XXXX
List unique terms, which by being defined, add to the reader’s understanding of the policy.
(Word and/or Phrase to Be Defined) – (Define the word and/or phrase to eliminate reader interpretation.)
Individual areas of responsibility followed by the function to be performed. List all the various employees and/or department’s responsibilities.
(Title/Department of Responsibility 1) – (State their responsibilities).
List of procedures that directly support this policy
Procedure 11.1.1 Establishing and Creating University Policy.
The forms and associated instructions that are used in direct support of the policy.
Form: (Form Name)
Instructions: (Title of Instruction)
Any lengthy or complex reference information that would disrupt the flow of the other sections.
Adopted: mm/dd/yyyy Approved by appropriate executive team member
Revised: mm/dd/yyyy Brief description of changes made.