DETERMINATION OF HONORARIUM STATUS
Payee Name:
Permanent Address:
Phone Number:
Social Security Number:
Describe the service performed for the University:
Date Performed:
Is the individual receiving the honorarium an employee to the University?
Yes No
Has the individual receiving the honorarium been offered and agreed to accept
a payment of fee contingent upon performance:
Yes No
Is the individual receiving the honorarium a U.S. Citizen?
Yes No
Department Head Signature:
Department Head Name (Print):
Approved Procurement Services:
Date: