Attachment II

Texas State University

Higher Threshold Personal Cellular Services Allowance Form

This form authorizes an employee an annual allowance that exceeds the threshold of $600.00 USD, for reimbursement for university use of their personal cell phone plan. Note: This allowance is intended to assist with the cost for usage of cellular service, and not necessarily to cover the total costs. (See Attachment I for Service Plans.)

In order to obtain a higher threshold allowance for an employee:

· Please complete this form including the allowance amount and obtain the employee and appropriate department head signatures.

· Submit Attachment II and PCR forms to the divisional vice president.

· After review and approval, the divisional vice president should:

o Review the Higher Threshold Personal Cellular Service Allowance Form with the president for approval;

o If approved, return a copy of the approved allowance forms to the appropriate department head; and,

o Forward the approved PCR to:

§ Human Resources for staff, hourly student employees and graduate students in divisions other than VPAA; or,

§ Faculty Records for faculty and graduate students in the VPAA division

Printed Name	Texas State PLID
Department	Work Phone/Cell Phone
Account Manager	Allowance Amount

Justification for Higher Threshold:
Vice President	Allowance Amount $

I have read UPPS No. 05.03.11, Wireless Cellular Communication Services, and understand:

1. The associated employee responsibilities.

2. That these allowances are considered taxable compensation subject to required tax withholdings; and,

3. These allowances are NOT part of my base salary.

Employee’s signature Date

Authorizing Signature Date

Division Vice President

Director of Athletics

________________________________

Authorizing Signature Date

President