Updated 10-31-19
Office of the Provost
Adjunct Request Form
To: Shannon Lattimore Date: ____________________
Office of the Provost
From: _____________________________
(chair signature)
ADJUNCT CONTRACT:
Term: _______________________ Course(s)& Credit hour(s): ________________________
_____________________________________
_____________________________________
_____________________________________
Adjunct Name: ________________________________________ DOB: _________________
Adjunct Contact: (phone)___________________ (address)________________________________
________________________________
(email)___________________ _________________________________
Rationale: Please explain why the adjunct is needed.
Provost Approval: ___________________________________ Date: _____________________
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