TEACHING/NON-RESEARCH OVERLOAD AUTHORIZATION FORM
As possible, this form is to be initiated before overload employment is undertaken.
Use “comment” section to justify exceptions to time requirement.
IDENTIFICATION OF INDIVIDUAL TO RECEIVE OVERLOAD
Name:______________________________________________________________ SSN:______________________________
Title:_____________________________________________ Department/Unit:______________________________________
Employment Basis: ______ 9 mo. ______ 10 mo. ______ 12 mo. ______ Part-time _____Other (Specify__________________)
Overload compensation (teaching and research) per fiscal year (July 1 - June 30) is limited to 20% of an employee’s annualized
salary, excluding displacement.
TEACHING OVERLOAD AUTHORIZATION
1. Academic Course Identification: (e.g., ENGL 101, Section No. 003)
Quarter: ________ Subject: ________ No. ________ Sect. No. ________ Enrollment: ________
2. Continuing Education Identification
Course Name: _________________________________________ No. of Meetings: _____________
Effective Dates: from _______________to ________________ Location:_____________________
3. One-time Compensation (e.g., one-time lecture, consultation, and similar payments)
Description of Activity:___________________________________________________________________________
Effective Date: _________________________________________ Location:_______________________________
4. Displacement Allowance:_________________________________________________________________________
PAYMENT
Account No. :__________________________________ Effective Date(s):_________________________________
Amount monthly________ Amount one-time payment___________ Date first payment ________Date last payment _________
Total Overload Compensation _____________________________
Total Revised Annual Compensation* (to be completed by Personnel):____________________________
*
add overload compensation to regular salary (excluding displacement)
List other teaching/administrative responsibilities documenting overload status of this activity. Attach workload form if
desired:
______________________________________________________________________________________________________
Comments: _____________________________________________________________________________________________
_______________________________________________
Requested by
_______________________________________________ _______________________________________________
Department/Unit Head Date Vice President Date
_______________________________________________ _______________________________________________
Dean of the College Date President Date
_______________________________________________ _______________________________________________
Budget Officer Date Personnel Office Date
Overload 11/01
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