Project to be Funded (Title or Description):
Entity Requesting:
State Agency:
Campus Receiving Funds:
System:
Agreement No.(if available):
Exemption Request:
Date of Request:
Date of Final Action:
Approved or Denied:
Rationale for Approval or Denial:
Approved Terms/ Language, if approved:
Type of Exemption:
Date of Exemption Termination:
Notes & Errata:
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