CHANCELLOR’S SIGNATURE
REQUEST FORM
1. This form must accompany ALL Chancellor signature requests.
2. Complete the form in its entirety.
3. Allow a minimum of 3 business days prior to the date needed for material review.
4. Call to confirm receipt of any faxed requests.
Submitted By:
Phone:
Date:
Division/Department:
Document Name:
REQUEST DETAILS
Time Sensitivity:
Priority-Date Needed
Fax to
Send via Campus Mail to
Will be picked up by
Mail to
Return Originals to
Send Copies to
Medium
Low
Attn:
Campus Address:
on
Applications for grants, program changes, etc., must include appropriate individuals.
Request
Approved:
___________________________________________ Date: _________________
Signature of Vice Chancellor/Dean/Department Chair
___________________________________________
Signature of Vice Chancellor/Dean/Department Chair
Date: ________________
TO BE COMPLETED BY CHANCELLOR’S OFFICE
Recipient:
Faxed to
Mailed to
Picked up by
Mailed to
Returned Originals to
Sent Copies to
Date: __________________________________
Attn:
Campus Address
on
Submit completed form to: UMKC Chancellor’s Office
5115 Oak St. 301 Administrative Center. Kansas City. MO. 64110
Email: chancellor@umkc.edu. Phone: 816.235.1101. Fax: 816.235.5588