(Over)
Bowie State University
Faculty/Staff Non-Instructional Overload Authorization
Employee Name:
Employee ID #:
Title:
Department:
Annual Base Salary:
Maximum Overload Amount (20%):
Current Employment Category (Check one) Date of Request _______
[ ] Faculty (complete all sections.)
[ ] Unclassified (Skip Section 1.) Acct. To Charge:
[ ] Classified (Skip Section 1.)
Section 1 - Current Extra Faculty Workload
Release Time - Is the faculty member currently receiving approved release time for any BSU
activities?
Yes No If yes, please complete the following:
Purpose(s) of Release Time Semester
FA - Fall
SP - Spring
SU - Summer
MI - Mini Semester
Number of Semester
Hours
Extra Compensation - Is the faculty member currently involved in outside employment? _ Yes X No
If yes, please complete the following. The following list must reflect any current additional BSU assignments or
outside employment for courses taught at other institutions for which the employee is being paid. List only those
activities that are NOT
a part of the employee’s regular full time BSU contract. For all current outside employment,
attach an outside employment form.
Type of activity
I - Instruction
S - Sponsored program
A - Administration
Extra Compensation
(Maximum authorized)
In instruction,
indicate course
prefix (Acronym &
Number)
Indicate
Location
BSU or 01
for other
Institution
Indicate
Semester
FA - Fall
SP - Spring
SU - Summer
MI - Mini
Semester
Number
Enrolled
per
course
Number
Semester
Hours
Section 2 - Requesting Department Certification
Department:
Overload Assignment: (Describe duties and responsibilities)
SCHEDULE: (Specify hours and dates when work is to be performed)
COMPENSATION: (Specify rate of pay and total compensation for this assignment)
$ ___ per___ ____ up to a total $___________
I certify that services of a contractual employee are unavailable for the above assignment.
_____________________________________ _________________________
Supervisor Date
Section 3 - Employee’s Primary Supervisor Certificate
I certify that release time is not feasible for the above overload assignment and that the assignment involves no
conflict of interest or commitment with the employee’s primary regular employment.
_____________________________________ _________________________
Supervisor Date
_____________________________________ _________________________
Vice President/President Date
Section 4 - Employee Certification
I certify that the performance of the above overload assignment will not coincide with the work hours of
my primary regular employment. During the current fiscal year, I have performed the following overload
assignments: (Specify dates and total compensation received)
_____________________________________ _________________________
Employee Date
APPROVED:
Director of Human Resources Date