Policy Template

Policy: [Number assigned to the Policy]

Title: [The name identifying the Policy]
Effective date: [The date the policy is to
be implemented]

University Council Proposal: [Yes/No,

which indicates whether or not the policy
originated from a University Council proposal. Yes __________ No __________
If yes, the policy requires UC approval for
changes to the policy]

Responsible University Officer:

[Appropriate member of Cabinet]

Responsible Office: [Name of the

University office with responsibility of
implementation of the policy]

Decision: Approved __________ Not Approved __________

Signature and Date:

Policy Statement [A well-articulated, authoritative expression of philosophy and direction. Does not change frequently.]

Policy Requirements [Required elements for any procedures supporting the policy. This could change frequently.]

Reason for Policy [Background information explaining the need and result of the policy. This could change frequently.]
Related Policy Information [Additional policy information that may be, but is not limited to: policy
support, restrictions to the policy, policy waivers, and policy sanctions. This could change frequently.]

Exclusions [Exclusions (groups of individuals, funding, etc.) to the policy - if none, it is assumed that the
policy applies across the University.]

Contacts [Offices/Units that can be contacted regarding the policy.]

Definitions [Unique terms that by being defined, add to the reader's understanding of the policy.]

Responsibilities [Individual areas of responsibility followed by the function to be performed.]

Procedures [List of procedures that directly support the policy.]

Forms and Instructions [List identifying forms and associated instructions that directly support the
procedures listed above.]

Appendices [Any lengthy or complex reference information that would disrupt the flow of the other sections.]

Additional Information

History [Audit trail of policy adoption and revisions. Will include the adoption date followed by revision
information which includes each revision date and a brief note explaining the revision.]