Staff Faculty Student
Time and Effort Certification
loyee Name: Position/Title:
Reporting Period: Department:
Record the actual percentage of your total effort expended to each obligation listed.
Sponsored Project Effort Detail: Grant Number % of Effort
(Identify the sponsored project(s))
Non-Sponsored Effort Summary Funding Source % of Effort
(Identify a summary of University obligations not sponsored by a grant)
Total Efforts (must equal 100%)
Number of Vacation Hours taken during reporting period:
I certify that the distributions of effort reflected on this report represent a reasonable estimate of the actual work performed
during the period covered by this report.
Certifying Official: Date:
I certify that I have first-hand knowledge of the activities performed by the employee identified above and that the distribution
of effort shown represents a reasonable estimate of the actual work performed during the period covered by this report.