IDAHO STATE UNIVERSITY CONSULTING APPROVAL FORM
Name of employee (Consultant)______________________________________________________
Position held at Idaho State University (ISU) ________________________________________________
Firm or individual for whom consulting service is to be provided (except when the privilege of confidentiality applies):
Name _________________________________________________________________________________________________________
Address/Phone__________________________________________________________________________________________________
Description of the proposed consulting services to be provided:
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Estimated duration of consulting contract: from _____________________to ____________________
Estimated hourly time to be spent by Consultant: __________________hours per______________
List any ISU facilities or equipment which will be used by the Consultant other than library and assigned office equipment and space:
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Describe provisions for appropriate reimbursement to ISU for use of the above facilities or equipment or provide documentation of
waiver of such reimbursement by the dean of the college:
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Other information
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
I certify that the above information is correct, that the individual or firm for which I will perform the service has been informed that I will
be acting as a private individual, and that the State of Idaho, ISU, its governing board, officers, agents, and employees are in no way
liable or responsible for workers’ compensation coverage and the performance of the services provided by Consultant. If ISU facilities
and equipment are being used, I further certify that the service does not constitute unfair competition, and that the fee is
commensurate with my professional standing. I certify that the proposed consulting will be done without interfering with the
performance of my assigned duties with ISU.
___________________________________________________________
Consultant Signature Date
I have reviewed the above request and if “Approved” is indicated below, it is my understanding and belief that the staff or faculty
member’s participation in the proposed consulting can be done without interfering with the performance of the staff or faculty
member’s assigned duties at ISU. If at any time the consulting service is deemed to interfere with the staff or faculty member’s duties at
ISU, the approval may be revoked.
Approved
or Disapproved ___________________________________________________________
Dean of College Signature Date
Approved
or Disapproved ___________________________________________________________
Provost’s Signature Date
Original to: Provost/VP for Academic Affairs Copy to: Dean of College and Consultant
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Vice President, Kasiska Division of Health Sciences
(for KDHS employees)
Vice President of Health Sciences
Supervisor Signature Date
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