Louisiana Tech University
CHECKLIST for PERSONAL, PROFESSIONAL, CONSULTING or SOCIAL SERVICES CONTRACTS
Name of Individual:
(Complete business checklist in addition to this checklist if representing a business other than a sole proprietorship.)
Services to be performed:
1. Are you a U.S. Citizen? Yes No
2. Are you a current Louisiana Tech Student? Yes No
Includes currently enrolled full and part time students.
3. Are you a current Louisiana Tech employee? Yes No
Includes fulltime and part time faculty and staff, graduate assistants,
and student workers.
4. Were you an employee of Louisiana Tech at
any time within the previous two (2) years? Yes No
Includes fulltime and part time faculty and staff, graduate assistants,
and student workers
5. Are you a current employee of a Louisiana State agency
or another Louisiana university? Yes No
6. Are you a current or retired member of EITHER Louisiana
School Employee’s Retirement System or Teachers
Retirement System of Louisiana? Yes No
You will be responsible for contributions from earnings to LSERS or TRSL.
7. Are you a child, spouse, brother, spouse of brother, sister,
spouse of sister, parent, spouse of parent, or parent of spouse
of a Louisiana Tech University employee who will: take part or
share responsibility to approve, disapprove, decide,
recommend, render advice, investigate, review a failure to
act or perform a duty with respect to the proposed contract? Yes No
8. Is this a contract for legal services? Yes No
Complete Form W-9 if not on file with Louisiana Tech before executing contract.
**If you answered NO to Question 1, a valid VISA must be confirmed by the
Comptroller’s Office before contract may be executed.
**If you answered YES to any of Questions 2 – 8, contact Purchasing Office
before executing contract.
By signing below, I hereby declare and affirm the information provided herein to be true and accurate.
