BUDGET ADJUSTMENT REQUEST-REVENUE PRODUCING ACTIVITIES Request Number_______________

(for OBPA/AOA/OOD use)

PART I (see instructions)

Name of Revenue Producing Activity(RPA)

New RPA Existing RPA (Check One)

Fiscal Year Fund Account

UDDS Activity

Brief Description of Revenue Producing Activity:

PART II (see instructions) (1) (2) (3) (4) (5) (6)

Original Red Book Prior Fiscal Yr Previously Approved Current Approved Budget Adjustment Request for New
Budget Encumberances Budget Adjustments Budget Request Budget or Revised
Brought Forward Budget

Cash Inflow:
Operating Revenue

Investment Revenue

Sales Credits

Total Cash Inflow 0.00 0.00 0.00 0.00 0.00

Cash Outflow:
Unclassified salaries

Classified Salaries

LTE Salaries

Student Wages

Fringe benefits

Supplies & Services

Capital

Aids-Financial Assistance

Special Purpose

Total Cash Outflow 0.00 0.00 0.00 0.00 0.00 0.00

Net Cash Inflow/
(Outflow) 0.00 0.00 0.00 0.00 0.00 0.00

Sufficient Cash Surplus

existed at Previous
Fiscal Year End: YES _______ NO _______

Budget Adjustment Request Prepared By: Reviewed By:

Date OBPA/AOA/OOD Signature Date

Approved By:
(1/97) Date