The undersigned Participant hereby agrees that the amounts specified above are the maximum amount(s) to be paid by
Tennessee Tech to Participant for Participant’s attendance and participation at the workshop/seminar described above.
F
orm must be completed prior to beginning of workshop/seminar. Following the workshop/seminar, to process payment,
department must submit a requisition in Eagle Buy, along with a completed copy of the form, receipts and an itemized travel
form. A W-9 Form should also be completed by each workshop/seminar participant, and emailed to APW9@tntech.edu
.
Workshop/Seminar Participation Form
This form is to be used
only
for workshop participants/attendees. For a speaker, presenter, or other individual
providing any type of service to the University, a personal/professional services agreement must be completed.
Name of Workshop/Seminar:
Dates of Workshop/Seminar:
Location of Workshop/Seminar:
University Department Hosting Event:
Maximum Payment to Participant:
$__________ per __________ day __________ week as a stipend.
$__________ for registration.
Department must provide receipts and an itemized
travel claim for reimbursable expenses that have
been broken out as per diem and travel
expenditures.
TTU Policy 506: General and Group Travel Policies
will apply.
$__________ per __________ day __________ week as a per diem for food.
$__________ for documented travel expenditures.
Total Maximum Payment: _______________
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.)
Minority/Ethnicity Code (Check any that apply):
African American (MA) Native American (MN) Hispanic American (MH)
Asian American (MS) Other Minority (MO) Specify: ____________________________
PI/Departmental Workshop Administrator’s Signature
Name of Workshop Organizer:
