RELOCATION AUTHORIZATION FORM

Armstrong Relocation, a United Van Lines agent, is the contracted mover of the LSU System www.lsu-relocation.com

Faculty/Staff Member: / Staffing Partner Phone:
Dept. Name: / Spouse Name:
Position Title: / Dept. Contact:
Campus/Hospital: / Choose oneLSU System (CC: 0)LSU Agricultural & Mechanical College (CC: 1)LSU at Alexandria (CC: 2)University of New Orleans (CC: 3)LSU Health Sciences Ctr: New Orleans (CC: 4)LSU Health Sciences Ctr: Shreveport (CC: 5)LSU of Eunice (CC: 6)LSU of Shreveport (CC: 7)Paul M Hebert Law Center (CC: 8)LSU Agricultural Center (CC: 9)LSU Health Sciences-Health Care Svcs (CC: 10)Pennington Biomedical Research Ctr (CC: 99) / Dept. Contact Phone:
Staffing Partner Name: / PeopleSoft Chart String (if applicable):
Is the entire move capped? / Choose oneYesNo / If Yes, what is the cap amount?
Is storage authorized? / Choose oneYesNo / If Yes, how many days are authorized?
Note: Storage may be paid through Foundation funds only.

Relocation Benefits Authorized

Household Goods Move: / Authorized: / Choose oneYesNo / Cap, if applicable:
Employee Origin Address
Street: / Apt: / City: / State: / Zip:
Home Phone: / Cell Phone: / Work Phone:
Employee Destination Address
Street: / Apt: / City: / State: / Zip:
Home Phone: / Cell Phone: / Work Phone:
Professional Goods Move: / Authorized: / Choose oneYesNo / Cap, if applicable:
Professional Goods Origin Address
Street: / Apt: / City: / State: / Zip:
Home Phone: / Cell Phone: / Work Phone:
Professional Goods Destination Address
Street: / Apt: / City: / State: / Zip:
Home Phone: / Cell Phone: / Work Phone:
Home Marketing Services (no Armstrong fee): Recommending realtors at origin who will help price, market, monitor, negotiate and facilitate closing.
Authorized: / Choose oneYesNo
Home Finding Services (no Armstrong fee): Recommending realtors at destination who will help price, market, monitor, negotiate and facilitate closing.
Authorized: / Choose oneYesNo
Mortgage Services (no Armstrong fee): Taking the faculty/staff member’s application over the phone and providing a convenient, cost effective option through an approved national lender.
Authorized: / Choose oneYesNo
Temporary Living Services (no Armstrong fee): Providing temporary housing with Armstrong’s reduced rates at more than 400,000 apartments in more than 2,000 U.S. cities.
Authorized: / Choose oneYesNo

Special Instructions/Comments:

Approval:

Department Head/Chair / Date / Dean (if applicable) / Date
Chancellor (if applicable) / Date / Date
Budget Code #1:
Budget Code #2:
Hire Date:

Send to the Office of Human Resource Management in 110 Thomas Boyd Hall.

Revised 4/1/2013 Page 1