Request to Change the Master University Department Table (MUDT) Form Checklist for completing the form Checklist for a departmental reorganization *Information requested on this form is essential and must be provided* Questions? Contact your Budget Analyst
Check all that apply: Add Change Freeze Department Subdepartment Department Head Name Change Only
Reason for the request:
Proposed New Data (see current sections below for proper coding): Executive Level (2 digits): Unit Level (2 digits): Department Number (5 digits): Department Description: Sub-Department Code (2 digits): Sub-Department Description:
Current Executive Level (complete if it exists, use FRS screen 2 or 6): Athletics (13) AVPres Admin & Operations (23) President (10) Provost and Exec VP Acad Affairs(20) Schools & Colleges (21) VP and CFO (11) VP and COO (14) VPres Student Affairs (25) VProvost Multicultural Affairs (27) VProvost Undergrad Educ & Admin (22)
Current Unit Level (complete if it exists, use FRS screen 2 or 6): Admin & Operations (50) Ag & Nat Resources (20) Architect & Engr Srv (63) Athletics (05) Avery Point Reg Campus (18) Business (23) Ctr Continuing Studies (33) Dining Services (74) Diversity & Equity (03) Education (24) Engineering (25) Enroll Plan/Mgt/Research (37) Facilities Operation (62) Fine Arts (27) Hartford Reg Campus (14) Health Services (71) HR & Payroll (56) Law (31) Lib Arts & Sciences (21) Nursing (28) Office of CFO (51) Office of Controller (53) Office of VP/CFO (02) Office of VP/COO (04) Pharmacy (29) President (01) Procurement & Log Serv (54) Prov & ExVP Acad Aff (10) Public/Enviro Safety (55) Residential Life (72) Social Work (32) Stamford Reg Campus (15) Student Activities (73) Student Union (75) Torrington Reg Campus (16) Tri-Campus (19) Undergraduate Education (13) Univ Info Tech Svcs (39) University Libraries (38) University Communications (80) Vice Provost UEA (11) VPres Student Affairs (70) VPres Res & Grad Ed (34) VProv Multicult Aff (12) Waterbury Reg Campus (17)
Current Department (complete if it exists, use FRS screen 2 or 6): Department Number (5 digits): Department Description: Sub-Department Code (2 digits): Sub-Department Description:
University Department Campus: Storrs Avery Point Hartford Stamford Torrington Waterbury
University Department Head Information: Name of Head Head Employee Number (6 digits) U-Box Number Phone Number Is he/she the Acting Department Head? Yes No
Effective Date of Change:
Authorized by (print) (must be at least 1 level up) Authorized by (signature) Date
If this is a change to an Academic area, has it been approved by the Board of Trustees? Yes No Have you attached the necessary Board of Trustees minutes or other documentation (Payroll Authorization, Official Memo, etc.)? Yes No