Fill - Free fillable ISU Consulting Approval Form PDF form

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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