Outside Time Commitment Form
(All time commitments combined should not exceed 15 hours per week)
Time Commitment Type: (please check all that apply)
Internship
Club
Daytime Work Study
Other: ________________________________________
Please note the number of credits you are taking: ____________
(18 credits or more require approval from the Assistant Director)
Time Expectation: (Please note the hours you would like to work)
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
Total Number of Weekly Hours= __________
CA Name: ___________________________________________________
Date of Request: ___________________________________________
Office Use Only
Meeting Date Regarding Request: ________________________________________
A.D. Signature: _____________________________________________________________
CA Signature: _______________________________________________________________
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