Shared Governance Request

Subject/Topic of Request

Requested By (person, group, department, committee, taskforce)

Contact Name *

Contact Phone Extension *

Contact Email *

Rationale: Please explain the issue/problem/concern or update/recommendation you plan to discuss with the SGC. *

Desired Outcome(s): Describe the outcomes or benefits expected.

Stakeholders: Identify the organizational area (departments, programs, divisions, etc) that will most need to be involved in the resolution of this issue.

Issue has substantial impact in these areas (check all that apply):

• Cross-function/institutional implications
• Policy/procedure implications (include number, if known)
• Funding implications
• Student impact
• Employee impact
• Community impact
• Other (include an explanation of the impact area)

If you chose Policy/procedure implications, and know the number, please type it here

If you chose Other, please type your explanation here

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