Supplemental Compensation Approval Forms (Internal and External)

Information on the Employee Receiving Supplemental Pay

Employee Name

Employee CWID

Date  of Request

Employee’s Home Supervisor

Employee’s Home Department

Employee’s Current Status (check one)

Full Time

Part Time

Employee’s Current Classification (check one)

Faculty

Staff

Employee’s Current Job Title

Details

Purpose of Supplemental Compensation

Please provide details of the activity requiring supplemental pay. 

For instruction, please list the course #, credit hours and the time taught (ex. MWF 8-9). 

For consulting or other supplemental activity, please identify the nature of the work.

Amount  of Supplemental Compensation Requested

Please be sure that the compensation does not exceed UA policy limits.

Full time faculty/instructors may receive up to 7.5% of their AY salary for one 3 hour course overload.  The expectation is that requests for supplemental compensation will be for no more than one 3 hour course per semester.  Please see UA policy for consulting daily rates.

                                                                                                                       not to exceed UA supplemental policy limits

Time Period

Please detail the period of service for this supplemental pay.

(Ex.  Fall semester, 8/16 – 12/31  or Jan 4-6, 2008) 

Be sure these approved dates are on the PA form.

Faculty/Instructor/Lecturer Teaching Loads

Please detail below the courses that the employee is teaching as part of his/her regular load during the period that he/she is requesting supplemental compensation. 

Please include the course number, credit hours, times taught and estimated enrollment. 

If none – please state “none”.

Return completed and approved form to the individual below (please print/type )

Name

Box/Address

Approvals

The University has the responsibility to assure that each faculty or staff member meets assigned duties acceptably before supplemental compensation is authorized and that compensation is not provided more than once for the same effort.  By signing this form, you are supporting this request.  Please sign and forward as indicated below.

Employee’s Dept Head (approving the activity over and above the normal workload)

Date

Employee’s Dean/Director/Division VP

Date

OAA Approval

Date

Information on the Employee Receiving EXTERNAL Supplemental Pay

Employee Name

Employee CWID

Date  of Request

Employee’s Home Supervisor

Employee’s Home Department

Employee’s Current Status (check one)

Full Time

Part Time

Employee’s Current Classification (check one)

Faculty

Staff

Employee’s Current Job Title

Details

Purpose of  EXTERNAL Supplemental Compensation

Please provide details of the activity requiring supplemental pay and the institution or organization for which you will be working and where the activity will take place.

Time Period – Specific days/dates to be engaged *

Please detail the period of service for this supplemental pay for the upcoming academic year.

Please note if work is to be done only on weekends or holidays.

Faculty/Instructor/Lecturer Teaching Loads

Please detail below the courses that the employee is teaching as part of his/her regular load during the period that he/she is requesting EXTERNAL supplemental compensation. 

Please include the course number, credit hours, times taught and estimated enrollment. 

If none – please state “none”.

Return completed and approved form to the individual below (please print/type )

Name

Box/Address

Approvals

The University has the responsibility to assure that each faculty or staff member meets assigned duties acceptably before supplemental compensation is authorized.  By signing this form, you are supporting this request.  Please sign and forward as indicated below.

Employee’s Dept Head (approving the activity over and above the normal workload)

Date

Employee’s Dean/Director/Division VP

Date

OAA Approval

Date