Request for Special Consultant Pay
Academic Affairs
CSU Channel Islands
Department/Program: Request Date:
Consultant Name:
EmplID or last 4 digits of SSN:
Project Name/Brief Description:
Accounting String:
Refer to the CSUCI Payroll Calendar for the appropriate pay period before completing the dates worked below.
A separate Request for Pay form must be submitted for each pay period.
Pay Period:
Dates Worked. Indicate each date worked individually:
Daily Rate ($):
Number of Days Worked:
Total Amount ($):
Department Authorization Signature:
Authorization Date:
Dean’s Signature:
Date:
HR/Payroll Office Use Only
PeopleSoft Position Number:
PIMS Position Number: 265 - - 4660 -
Unit # PIMS Job Record #
Days Remaining:
Dollar Amt Remaining:
Payroll Authorization
Processed by
Date Processed
$0.00