Spreadsheet: 0fa04e00-f8c8-4d06-ade9-24ce60c6c106
Sheet: FORM A - Authorization to Earn

 | [NAME]
 | (All supplemental compensation is subject ULS board approval and a McNeese audit.)
 | An eligible request to earn supplemental compensation will require advanced approval, and pay will not occur until approved by the Board.  An approval will be obtained through University administrative processes, in accordance with [NAME]'s policy SUPPLEMENTAL COMPENSATION FOR FACULTY AND STAFF.  All requests are submitted as Board material to be ratified at its scheduled meetings.
 | PLEASE PRINT
 | Last Name, First Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Department Name
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Faculty |  |  |  | Type of Service  (ü) |  |  |  |  | Seminar / Training / Community Services
 | [NAME] ID |  |  |  |  |  |  |  |  |  |  |  |  |  | Staff |  |  |  |  |  |  |  |  | Electronic Learning
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Athletics
 | Title of Event / Project |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Research & Sponsored Programs
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | BUDGET SOURCE
 | Description  (titles of seminar, projects, training, |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Account No.
 | activity, service, course, etc) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Account Name
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ESTIMATE OF COMPENSATION
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ** Faculty Status - do not complete  Est. Hrs. Worked
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | and Hourly Rate / Hr.  Enter amount in Est. Compensation
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | field.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ** Electronic Learning - Internet or Web Based Course
 | Service Date(s) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | A faculty who develops and initiates an internet or web-based course will receive $1,000.  Enter this amount in Est. Compensation field.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Est Hours Worked
 |  |  | Attach supporting documents |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Hourly Rate / Hr.
 |  |  | Ex. brochures, programs, etc. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Attach a written justification for hourly rate.
 | PAYMENT OF EARNED COMPENSATION |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Est Gross Payment Amount to Employee |  |  |  |  |  |  |  |  |  |  |  |  | $
 | (Complete FORM B) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | + Medicare Benefits (contact Payroll) |  |  |  |  |  |  |  |  |  |  |  |  | $
 | A check Request for Supplemental Pay Compensation is  required to authorize Payroll to process payment. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | +  Retirement Benefits (contact Payroll) |  |  |  |  |  |  |  |  |  |  |  |  | $
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Est Compensation and Benefits Budget |  |  |  |  |  |  |  |  |  |  |  |  | $
 |  |  |  |  |  |  |  |  | `
 | CERTIFICATION |  |  |  |  |  |  |  |  |  |  |  |  |  |  | APPROVED BY
 | I accept this authorization to earn supplemental compensation for work that will be performed outside of my normal work duties and the work activity will be different from my normal duties.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | `
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Department Head or PI / Date |  |  |  |  |  |  |  |  |  |  | [NAME] or Director / Date
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Research  Services / Date |  |  |  |  |  |  |  |  |  |  | [NAME]
 | Employee's Signature / Date |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Vice President / Date |  |  |  |  |  |  |  |  |  |  | President / Date
 | For Office Use Only:  ULS BOARD APPROPVAL (Meeting Month & Date)
 | Distribution:  DH, HR, Academic Affairs, Research Services (if applicable), Payroll |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Form Amended 7/8/2014