CELL PHONE REIMBURSEMENT REQUEST

Data/Cellular Usage Levels

Level III - Necessary

Level II - Beneficial

Level I - Incidental

Need for Accessibility

Accessibility required throughout work day and occasionally after hours

Limited or occasional need for accessibility during work day

24-hour accessibility required

and/or-

and/or-

Need for occasional e-mail notification or data communication

E-mail and other electronic communication can wait until normal work day

and/or-

and/or-

and/or-

and/or-

Phone usage required during the work day

Phone usage required during work day and occasionally during off hours

Phone usage required during work day, as well as frequent off-hour usage required

Data Usage

Frequent or constant electronic and data communication is required

Phone Usage

$25.00 per month

$37.50 per month

$50.00 per month

Stipend

USAGE LEVEL        CELL PHONE NUMBER          

APPROVED BY:                        

      Supervisor’s Signature            Date

     Supervisor’s Name – Printed

MUST INCLUDE A COPY OF YOUR MOST CURRENT CELL PHONE BILL FOR VERIFICATION PURPOSES.

PLEASE RETURN TO HUMAN RESOURCES.