Complete this form to propose a new policy be added to the PPM.

Policy Developer Information

Policy Owner

Administrative Unit, Department, and Position Title

Email and Phone Number

Proposed Policy Needs Assessment and Development Plan

Policy Title

Chapter in PPM

Provide a summary of the purpose, background, development process/actions, topics addressed, and justification for the policy

Does the policy have campuswide impact?

Yes

No

Describe the units and constituencies impacted by the policy

Which offices, departments, and individuals will be or have been consulted during development?

List the policies and regulations that are related or should be referenced, including the source document

List the primary stakeholder departments

Proposed development schedule including desired implementation date

Provide the communication and training activities that will be conducted to build awareness and enable effective policy implementation

Has your Vice Chancellor's/Vice Provost's/Dean's office approved your policy proposal?

Yes

No

Provide a summary of potential disproportionate or undesirable impacts on under-served and marginalized individuals or groups