ORSP RESEARCH INCENTIVE PAYMENT
REQUEST FORM
SUBMISSION INSTRUCTIONS: Once all approvals are obtained, submit form to ORSP, SF302
Please refer to the Guidance for Providing Research Incentive Payments for requirements and restrictions
Attach additional documentation to this form if needed.
PREPARER INFORMATION
Name o
Preparer Department
Phone Email
Date
Chartfield
Accou
n
t
- Fund - Dept ID - Program - Project - Class
Is this payment being paid thru a research grant?
Yes No
# pages, including this form
DEPARTMENT APPROVAL
Department/PI Approver Name Si
nature Date
ORSP APPROVAL
Approver Name Si
nature Date
rev. March 8, 2019
Requestor’s Name: __________________________________________________________________________________
Number of Research Incentives: ____________ Amount for Each Incentive: ___________
Are recipients current CSUEB Students?
___
Yes ___ No
Are recipients current CSU Employees? ___
Yes ___ No
* Note that Principal Investigators (PI’s) have the option to provide or not provide research incentive payments to
research participants. For optional payments to current CSUEB students, University Student Account Credits
will be provided as incentive payments. For optional
payments to Non-CSU Employees, gift cards will be
provided as incentive payments. Current CSU Employees are NOT permitted to receive incentive payments.
Purpose of Request: ________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Special Instructions: _________________________________________________________________________________
___________________________________________________________________________________________________
