N O N - U N I V E R S I T Y E M P L O Y M E N T R E Q U E S T
Academic Affairs
Academic year: 20 _________ - 20 _____
Name: __________________________________________________ School/Department: ___________________________
Last First Middle
In accordance with the provision of Paragraph four of the Faculty Contract, concerning agree ment of faculty member
not to obligate himself/herself for any outside employment nor to accept outside positions or responsi bilities with non-
university enti tles without prior and written approval of the Dean and Vice President for Academic Affairs, a request is made
that the following non-university employment or activity be authorized. Outside employment for monetary compensation
should be limited to 8 hours per week or one 3 -hour class per academic year at another institution.
I will not be involved in any outside employment.
I will be involved:
Des cr ip tio n o f W o rk o r Ac ti v i ty
B us i n ess or Or g an iz a ti on f o r No n -u niv ers i ty E mp l oym e n t or A c t iv i ty
Name Owner or Super visor
Address Phone
Dates of Employ men t o r A ctivity
Beg in : ________________ End: _______________________
Month Date Year
Sp ecif ic Hou rs / D ay s of E mp loy men t o r Activ ity
From: ____________________________To: ________________________
Day a.m. / p.m. a.m. / p.m.
Remarks/Description of Outside Employment:
Sig ned : _______________________ ___ __ ___ __ _____ ___ __ __
Signature of Faculty Member Date
Action
Approved Not Approved __________________________ _ _______________________
Dean Date
Approved Not Approved __________________________ __ _______________________
Vice President for Academic Affairs Date
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