WORKSHOP/SEMINAR PARTICIPATION FORM
The undersigned Participant hereby agrees that the amounts specified below are the maximum amount(s)
to be paid by Tennessee Tech to Participant for Participant’s attendance and participation at the
Workshop/Seminar described below.
Name of
Workshop/Seminar
Dates of
Workshop/Seminar
Location
of Workshop/Seminar
University Department
Hosting
Workshop/Seminar
Name of Workshop
Organizer/Administrator
Banner Index
The University will pay
Participant
up to
(a) $__________ per __________ day __________ week as a per diem for food.
(b) $__________ per __________ day __________ week as a stipend.
(c) $__________ for documented travel expenditures.
(d) $__________ for registration.
Total: _____________________________________
In no event will any reimbursement for travel, meals or lodging, exceed the amounts provided for in the current version
of Tennessee Tech’s travel policies.
Other terms (N/A if none):
Are you a citizen or permanent resident of the United States? Yes No
(If you selected “No,” please contact the Workshop Organizer/Administrator immediately for instructions on how
to proceed.)
Revised 10/1/2018
Form must be completed prior to beginning of workshop and submitted in Eagle Buy upon workshop completion
as an attachment to a requisition for payment to the participant. A W-9 Form should also be completed by each
workshop participant.
Minority/Ethnicity Code (Check one):
African American (MA)
Native American (MN)
Hispanic American (MH)
Asian American (MS)
Other Minority (MO) Specify: _______________________________
Signed:
PI/Departmental Workshop Administrator’s Signature
Printed Name