APPENDIX III: POLICY/PROCEDURE PROPOSAL FORM

KENTUCKY STATE UNIVERSITY IN ALL THINGS EXCELLENCE

Policy/Procedure Proposal Form

Date Submitted * 1/27/2022

Requestor name *

First ___ MI

Last Suffix

Requestor email *

Policy Type * New Revised

New Revised

Proposed Policy/Procedure Name *

1. Policy Statement/Procedure Description *

Description of the actual policy covering topics which include duties assigned to responsible parties and other parties as necessary; other information specific to a particular policy or procedure subject as needed; and a description of the compliance review process.

2. Entities Affected *

Bulleted list of areas of the University that are affected by the policy or the procedure.

3. Policy Owner/Interpreting Authority*