Tennessee State University
CONTRACT ROUTING AND APPROVAL FORM
(All spaces must be completed.)
CONTRACTOR/COMPANY INFORMATION
Contractor Name
Contact Person
Address
City, State, Zip
Email
Tel
Fax
REQUESTING DEPARTMENT
Department Name
Contact Person
Email
Telephone #
Tel
Fax
CONTRACT DESCRIPTION/INFORMATION
Purpose of Contract
(brief description)
Term of Contract
Contract Amount
Start Date
$
Purchase
Req. No.
Tel
Fax
 General Funds  Grant Funds/Federal  Grant Funds/State  Restricted Funds
 Revenue Generating  Title III
 Other:
Contract Monitor
Type of Funding
Type of Contract
(Check all that apply)
Attachment
Checklist
(Check all that are
attached)
End Date





Account No.
Contract for Workshop/Seminar
Amendment/Renewal
Personal/Professional/Consultant
Use of Campus Facility
Clinical Affiliation





Non-Standard (Vendor-Generated)
Dual Services
License/Renewal
Service Maintenance
MOU/MOA
 Purchase Requisition (if required)
 Justification for Non-Competitive Purchase ($5,000 &
 Original contract (for Amendments)
 IRS W-9 Form (required)
 Minority Ethnicity Form (required)
 Letter to Justify Late Submission
Up)
 Letter to Justify for After-the-Fact
CONTRACT CERTIFICATION & APPROVALS
I certify that I have read the attached contract/agreement and that the requesting department will comply with all its requirements.
I recognize that while the Office of Procurement and Business Services or the Office of the University Counsel may review the
contract from a legal or policy perspective, it is the requesting department’s responsibility to ensure the specifications are sufficient
and/or practical for departmental needs and to monitor the contract for compliance, payment and expiration.
PRINT NAME
SIGNATURE
Department Contact
Person/Initiator
Date
Department Head
Date
Dean/Director
Date
Assoc./Asst. Vice
President (If
applicable)
Date
Vice President
Date
TSU/Legal Rev.8/2013