1.	Policy Statement

2.	Affected Stakeholders

Indicate all entities and persons within the university affected by this policy:

☐Alumni	☐Graduate Students	☐Undergraduate Students

☐Staff	☐Faculty	☐Student Employees

☐Visitors	☐Vendors/Contractors	☐Other:

3.	Exclusions or Exceptions

4.	Definitions and Acronyms

5.	Process and Procedures

6.	References, Associated Policy(ies), and Supporting Documents

7.	Policy Attributes

Responsible Office(s)
Approving Officer or Body
Date Approved
Publication Date (if different than approval date)
Next Review Date