UNIVERSITY OF PITTSBURGH \ FORM  INSTRUCTION GUIDE



FORM TITLE:              FORM APPROVAL
NUMBER:                  FORM 0002 PITT 1214
PROCEDURE:               01-01-03



ENTER THE FOLLOWING INFORMATION WHERE INDICATED:

    1.    FORM or FORM/PITT Number  (See Policy 01-01-03, Establishing
          University Forms, Paragraph II.B., FORM Numbering)

    2.    Document Number of the University Procedure associated with
          the form (in which the form appears as an exhibit together
          with a form instruction guide)

    3.    FORM APPROVAL Page Number

    4.    Date

    5.    Form Title

    6.    Intended Purpose of the Form

    7.    Number of Parts desired

    8.    Type of Form (Carbon or Carbonless)

    9.    Printer (Central Printing, Computing and Information Systems,
          or outside vendor)


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APPROVALS

   10.    Signature of Data Administrator required with date