St. Olaf College Cellular Phone Allowance Request Form S

St. Olaf College
Cellular Phone Allowance Request Form
Employee Name:
Unit Number to Charge:
Account Activity Subcode
Check the justification(s) that apply and provide a brief explanation.
More than 50% of work is conducted away from the campus office and there is frequently an urgent
need to reach the employee to transact timely College business-related communications.
The employee must be regularly contacted for crisis and/or emergency situations after normal business hours.
The employee is on call 24/7.
Type of cellular device request:
College owned
On-Call shared department phone for multiple individuals or working hour use only
Taxable allowance: Monthly voice allowance ($20)
Monthly voice & Data allowance
($50 or actual cost, whichever is less)
Month to begin cell phone allowance:
***You must attach a detailed copy of your most recent bill as documentation to justify the allowance.
The allowance must fairly represent only the business use of the phone, and the employee
must contact his/her supervisor in writing if the business usage significantly declines for a sustained period.
Please note that this allowance will continue until the payroll office is notified otherwise or until the college reassess the plan and amounts.
The allowance will be included as taxable income on the employee's W-2. Appropriate payroll taxes on the allowance amount will be
withheld from the paycheck, and the amount of the allowance will be included on the eligible employee's year-end W-2. The allowance
does not constitute an increase to base pay, and will not be included in the calculation of percentage increases to base pay due to annual raises,
job upgrades, benefits based on a percentage of salary, etc.
Employee Certification
I certify that the requested cell phone services are needed for St. Olaf business purposes. I have read, understand and intend to comply with the
College's cellular device policy. (insert URL) I never store or transmit St. Olaf confidential data with my cell phone. I have read the data security
policy and am aware of the rules and data elements that are subject to data privacy rules.
I will not use my cell phone to conduct St. Olaf business while driving or operating machinery.
Employee Signature:
Printed Name:
Supervisory Signature:
Printed Name:
Approved ( )
Vice President & CFO:
Please send completed form to the Telecom Office
S:\Business\Cell Phone\Cellular Device Form 02.26.2016.xls
Not Approved ( )