AAMU – Title III Strengthening Grants Program Form 5 – Updated 10-1-14
REQUEST FOR CONSULTANT SERVICES
Name of Unit requesting consultant services: ____________________________________________________________________
Name of individual requesting consultant services: ________________________________________________________________
Phone Number: _________________________________________ Fax Number: ______________________________________
Purpose of Consultant’s visit: __________________________________________________________________________________
Specifically, what will be done and how? (Attach an additional sheet if necessary)
Name of Suggested Consultant: ______________________________________________ (Please attach the consultant’s resume.)
Address: ____________________________________________________________________
E-mail Address: ___________________________________ Phone Number: _______________ Fax Number: _______________
Title: __________________________________________ Company/Organization: _____________________________________
Date(s) of Consultant’s Visit: _______________________________________ Rate of pay for Consultant: ___________________
Fee __________ Source of Payment: (Enter dollar amount)
Per Diem__________
Travel __________ Title III: __________
Other __________
TOTAL __________ University: __________
If the consultant is an employee of Alabama A&M University, the Program/Project Coordinator must answer the following:
Will consultation be across department lines? Yes No
Will the work to be performed by the consultant be in addition to the regular work load? Yes No
Will the consultant involve a separate or remote operation of the work performed by the Yes No
consultant in addition to his/her regular work load?
If the consultant is not an employee, please explain why an outside person was chosen.
Consultant Services Approval
_______________________________ __________
Faculty/Staff Requesting Services Date
_______________________________ __________ _______________________________ __________
Signature of Supervisor or Dean/Chair Date Provost and V.P. for Academic Affairs Date
_______________________________ __________ _______________________________ __________
Title III Director Date President Date
Title III Action
Services Awarded Date: ______________
Services Denied Reason for denial: _______________________________________________
_______________________________________________________________
