Request for Consulting Services
Academic Affairs
CSU Channel Islands
Is this consulting work funded by a federal grant?
Yes No
Brief Statement of Scope of Work:
Relevant Skills and Academic Background of Consultant:
ii
Product or Deliverables of the Employment:
Consulting Period Start Date:
iii
Consulting Period End Date:
Recommended Daily Compensation:
iv
Recommended By: (Print Name)
Signature: Date:
Approved By: (Print Name)
Signature: Date:
Consultant Information
i
Last Name:
First Name:
Emplid or last 4 digits of SSN:
Street Address:
City: State: Zip:
Phone (Day):
Phone (Eve): Email:
i This form must be accompanied by an Employee Requisition.
ii Attach a CV if not already employed by CSUCI.
iii
Consulting Period Start and End dates must match dates on the accompanying Employee Requisition.
iv
Amount must be reflected in whole dollars as a “daily” and NOT hourly amount.
