POLICY ACTION REQUEST FORM

This form should be completed prior to initiating the development of a new policy, the revision of an existing policy, or the retirement/rescission of an existing policy (“policy action”). Please consult the Policy on Policies for additional information. Please email policies@drew.edu with questions.

In each section of the form, delete instructions after inserting the necessary information and/or when you no longer need them.

Policy Name:

Proposed policy name

Action Requested:	☐New Policy ☐Revision to Existing Policy ☐Policy Reviewed - No Revision Required ☐Interim / Emergency Policy ☐Retirement / Rescission of Existing Policy
Policy Owner:	Title of Designated Cabinet Member
Responsible Office:	Department/Unit
Responsible Officer:	Title of Designated Employee
Date Submitted:	Click or tap to enter a date.
Desired Effective Date:	Click or tap to enter a date.

If there are legal requirements, strategic priorities, or other factors that impose time constraints on the issuance of this policy, please explain.

*If an existing policy has been reviewed and no revisions are required, skip to section 3.3 Review and Approval of Policy Action Request. The Policy Owner is to complete Section 3.3 and send the current version of the policy, along with this completed page to policies@drew.edu for posting to the University Policy Library.

STEP 1: INITIAL ACTION

Complete Sections 1-3 and submit it to the Policy Owner before drafting the policy.

ASSESSMENT OF NEED

1.1 REASON FOR REQUEST

Address the following points, as applicable:

Explain why the proposed action is requested.

Indicate if a change in local/state/federal law or regulation has prompted this action.

State what legal, regulatory, financial, operational, accreditation, technological, and/or social requirements this policy action addresses.

Identify what advantages this policy action will bring to the university.

Identify what risks this policy action helps control.

Section 1.1 text

1.2 REQUESTS TO DEVELOP NEW, REVISED OR INTERIM / EMERGENCY POLICIES

Complete this section if the requested policy action is to create a new policy, revise an existing policy, or to create an interim/emergency policy. If requesting to retire/rescind a policy, write (“N/A”) in this section. Address the following points, as applicable:

Write 2-5 sentences summarizing the principles of the proposed policy/policy revision and briefly outline the procedures to be used to implement it.

State clearly the problem this policy is targeting. Precisely state the way(s) this policy will solve this problem.

Outline (some of) the procedures this policy requires of the university community that will deliver this solution.

You may want to indicate, generally, the scope of the policy, e.g., what operational activities of the university will be affected, and what related areas will not be affected.

Section 1.2 text

1.3 REQUESTS TO RETIRE/RESCIND AN EXISTING POLICY

Complete this section if the requested policy action is retirement/rescission of an existing policy. For all other requests, write “N/A” in this section.

Explain the risks addressed by the current policy. Explain how those risks will be managed after the policy is rescinded.

If the content of the policy will be posted online as a guideline, procedure or other guidance document, please attach or include a URL for the document.

Describe how and to whom the rescission/retirement will be communicated.

Provide a copy of the current policy with this form.

Section 1.3 text

IMPACT ASSESSMENT

2.1 STAKEHOLDERS

What categories of individuals (e.g., students, staff, faculty, etc.) will be most affected by the policy action?

2.1 section text

What other units, if any, will be affected by the policy action?

☐Academic Affairs	☐Registrar

☐Athletics	☐Research

☐Business Affairs	☐Student Affairs

☐Human Resources	☐University Advancement

☐Information Technology Services	☐University Communications

☐Library	☐Other__________________

☐Public Safety	☐Other __________________

2.2 SYSTEMS AND PROCESSES

What changes in existing systems and/or processes should take place in order to ensure compliance with this request, if granted? Consider your area and those of stakeholders impacted by the proposed policy action.

Section 2.2 text

2.3 RESOURCES

What resources (human, financial, physical, operational, technological, and other) might be needed to implement and maintain compliance with this policy action? For a request to rescind an existing policy, explain the impact the proposed action may have on existing resources, if granted.

Identify what change, if any, to Drew’s culture and/or behaviors may be needed to ensure compliance.

If the request is to rescind a policy, how will existing resources be impacted by the rescission?

Section 2.3 text

DRAFTING PLAN

3.1. DRAFTING GROUP

List the individuals who will or have been involved in the development of this policy along with their unit and title.

For requests to rescind an existing policy, identify individuals who will or have been consulted and provided an opportunity to share feedback on the request.

Section 3.1 text

3.2. BENCHMARKING

List other institutions whose policies may be used as models in the development of this new or revised policy. Include URLs if available.

For requests to rescind an existing policy, please provide benchmarking information highlighting the approach taken by other institutions relevant to the policy topic. Include URLs if available.

Section 3.2 text

3.3 REVIEW AND APPROVAL OF POLICY ACTION REQUEST

The Policy Owner and Policy Review Team will review the request and may provide feedback on the proposed policy action in this section.

Department / Unit	Date Submitted	Approval	Date Reviewed
Approval Authority (if request is to retire/rescind a policy)	Click or tap to enter a date.	☐Approved ☐Not Approved ☐See recommendations	Click or tap to enter a date.
Policy Owner	Click or tap to enter a date.	☐Approved ☐Not Approved ☐See recommendations	Click or tap to enter a date.
Policy Review Team	Click or tap to enter a date.	☐Approved ☐Not Approved ☐See recommendations	Click or tap to enter a date.

Once you have completed this section of the form and the policy action has been approved, please proceed as appropriate (i.e., draft or revise the policy) before moving on to Step Two: Final Action.

STEP TWO: FINAL ACTION

Please complete Section 4 and forward this form with the policy/policy revision(s).

For requests to retire/rescind a policy, please complete Section 4.2.

IMPLEMENTATION

4.1 REVIEWERS

List the names and functions or title of each department and/or individual who provided feedback on the proposed draft.

Section 4.1 text

4.2 COMMUNICATION AND TRAINING

Describe the communications and training activities that will be conducted to build awareness and support implementation.

Indicate whether there are federal, state, local or other requirements for training related to this policy.

Section 4.2 text

4.3 COMPLIANCE

Regulatory Compliance. Is there a state, federal, local or University compliance obligation associated with this policy? If so, list the regulatory body (i.e., OSHA, DOE, etc.) and the name of the law or regulation.

Procedures. Are there procedures associated specifically with compliance? If so, list them or provide an online reference.

Reporting Requirements. Are there reporting requirements to government agencies or the University? If so, at what frequency?

Audits. Are there external/internal audits? At what frequency? What costs are associated with audits?

Risks. What are the institutional risks of noncompliance? What are the consequences for an individual who does not follow this policy?

Section 4.3 text

5. FINAL REVIEW AND APPROVAL OF POLICY ACTION

The Policy Owner will forward the draft and this form through the approval process. For minor revisions, a redlined changes document must be submitted and archived with the Policy Action Request Form.

Department / Unit	Date Submitted	Approval	Reviewer’s Signature and Date Reviewed
Approval Authority	Click or tap to enter a date.	☐Approved ☐Not Approved ☐See recommendations
Policy Owner	Click or tap to enter a date.	☐Approved ☐Not Approved ☐See recommendations
Responsible Office	Click or tap to enter a date.	☐Approved ☐Not Approved ☐See recommendations
Policy Review Team	Click or tap to enter a date.	☐Approved ☐Not Approved ☐See recommendations