REQUEST FOR APPROVAL OF USE OF UNIVERSITY RESOURCES IN
CONJUNCTION WITH OUTSIDE ACTIVITY
(Whether compensated or not)
If requesting use of University resources in conjunction with Outside Activity, you must complete this form.
This Portion to Be Completed by Employee
Employee Name:
Department:
From:
Date of Outside Activity:
To:
Outside Activity/Employer:
I hereby request permission to use the University resources listed below in the conduct of the aforementioned outside
activity:
Facilities (list):
Equipment (list):
Services (list):
Employee's Signature Date
This Portion to Be Completed by Department Head
I recommend the request for University resources be:
Approved Disapproved
Date
Department Head's Signature
DisapprovedApproved
The use of University resources is:
This Portion to Be Completed by Vice President for Finance & Administration
If approved, indicate charges, if any, for use of the University resources.
Resource Charge
ChargeResource
Charge
Resource
Date
Vice President's Signature
Distribution: Original to Human Resources
Copy to Employee
Revised: 5/10/2016
