1. EMPLOYEE TO RECE IVE THE HONORARIUM
2. FORM AND DOLLAR VALUE OF THE HONORARIUM
3. PERSON/ORGANIZATION PROVIDING THE HONORARIUM
4. DATE(S) AND TIME(S) OF THE ACTIVITIES
5. WHAT WILL EMPLOYEE DO IN EXCHANGE FOR THE HONORARIUM?
EMPLOYEE SIGNATURE DATE
Request for College Approval of an Honorarium
The Washington State Ethics in Public Service Law requires that state employees may not accept honoraria without
prior approval by the employing agency. College employees considering a task where an honorarium may be paid
should complete this form, have it approved by their supervisor and route it to the Vice President for Human Resources.
RCW 42.52.010 denes “honorarium” as: “money or thing of value oered to a state ocer or state employee for a speech,
appearance, article, or similar item or activity in connection with the state ocer’s or state employee’s ocial role.” (Refer
to the Edmonds CC ethics policy No. 6.3.104 and regulation No. 6.3.104 R101 for a related discussion of gifts, outside
employment and reimbursement for reasonable expenses, all of which are not within the denition of “honorarium.”
PROPOSED HONORARIUM
REV. 03/11 | 10-11-090 B
EMPLOYEE CERTIFICATION
The activities and honorarium listed above do not constitute a conict of interest under RCW 42.52 (Ethics in
Public Service Law) or the Edmonds CC policy and regulation. The activities required do not conict with my work
assignments. The activities will be performed outside my regular work hours, or I agree to take annual leave or leave
without pay if the activities are during regular work hours.
EMPLOYEE SUPERVISOR SIGNATURE DATE
SUPERVISOR APPROVAL
COLL EGE APPR OVAL
The activities and honorarium listed above do not constitute a conict of interest, do not conict with the employee’s
assigned duties, and are not prohibited by RCW 42.52.130. Accordingly, the honorarium is approved.
VICE PRESIDENT FOR HUMAN RESOURCES DATE
RETURN COMPLETED FORM TO HUMAN RESOUR CES
