New Account / Cost Center Request
Requester University ID (UCLA)
Requester EmplID (UC Path ID)
Where can I find the ID?
Requester Last Name
Requester First Name
Middle Initial
Requester Email
Requester Phone
Ext
Requester Department Name
Requester Title
Please confirm that you have authority to request changes to the fund(s) listed on this form
Yes, I have authority to make this request.
No, I do not have authority to make this request.
Verification Information
Please provide information of the person who has authority to request transfer.
Last Name
First Name
Middle Initial
Email
Phone
Ext
Department Name
Title
Please mention the nature of you request
Create new Account
Create new Cost Center
Link existing Cost Center to existing Account
Update Account - Cost Center Title
Close Account
Close Account / Cost Center
Are the Accounts to be created for a new Department?
Yes
No
Account Information
Account Department Code
Title of Account
What category would this account fall under?
Please select...
Academic Support (43xxxx)
Auxiliary (76xxxx)
Balance Sheet (1xxxxx)
Clinical Edu (41xxxx)
Clinical Ops (46xxxx)
Graduate Student Financial Aid (78xxxx)
Institutional Support (72xxxx)
Instruction (40xxxx)
Operation & Maintenance of Plant (64xxxx)
Public Service (62xxxx)
Research (44xxxx)
Revenue (21xxxx)
Student Services (68xxxx)
Teaching Hospital (42xxxx)
Undergraduate Student Financial Aid (77xxxx)
Organized Research (56XXXX)
Function Code
Please select...
Auxiliary Enterprises
Balance Sheet
Financial Aid
General Admin & Institutional Service
General Campus Instruction & Research
General Campus Organized Activity
General Campus Organized Research
General Campus Public Service
Health Science Instruction & Research
Health Science Organized Activity
Health Science Organized Research
Maint & Operation of Physical Plant
Plant Accounts
Revenue
Student Services
Summer Session
Teaching Hospitals & Clinics
UCLA Libraries
University Extension
List existing Cost Centers you want to link to the new Account
Enter multiple Cost Center separated with a comma.
x
Is there a similar account that you would like this new account to follow?
Similar Account
Account Number
x
Similar CC
Cost Center
x
Attach excel sheet with Account/CC details
Special Instructions
Cost Center Information
Cost Center
If the department has chosen a Cost Center
x
Title of Cost Center
Is this a PI Cost Center
Yes
No
PI Last Name
PI First Name
PI Middle Initial
PI University ID
Is the PI in accordance to
Policy 900
and a part of UCLA's Academic Senate?
Yes
No
Does the PI have a payroll appointment that matches the account department?
Yes
No
Attach PI Exception Letter
What Account(s) do you want to attach this cost center to?
Enter multiple Accounts separated with a comma.
x
Special Instructions
Close Account
Close Cost Center
Update Account - Cost Center Title
Link existing Account to existing Cost Center
Account / Cost Center
Account
Cost Center
Title of Cost Center
Is this a PI Cost Center
Yes
No
PI Last Name
PI First Name
PI Middle Initial
PI University ID
Is the PI in accordance to
Policy 900
and a part of UCLA's Academic Senate?
Yes
No
Does the PI have a payroll appointment that matches the account department?
Yes
No
Attach PI Exception Letter
Cost Center
I confirm all the fund balances are cleared
Existing Account/CC Title
Enter multiple Cost Center separated with a comma.
x
New Account/CC Title
Enter multiple Cost Center separated with a comma.
x
Comments
Contact Information
