Spreadsheet: 00172210-dc93-40aa-a937-2975a26c21d3
Sheet: FORM A - Authorization to Earn

 | [NAME]
 | (All supplemental compensation is subject to 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.
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 | Last Name, First Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Department Name
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Faculty |  |  |  | Type of Service  (check o ne) |  |  |  |  | Seminar / Training
 | [NAME] ID |  |  |  |  |  |  |  |  |  |  |  |  |  | Staff |  |  |  |  |  |  |  |  | Electronic Learning
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Athletics
 | Title of Event / Project |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Research & Sponsored Programs
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Service Date(s)
 | Description  (titles of seminar, projects, training,
 | activity, service, course, etc)
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Supporting Documents are attached.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Ex. brochures, programs, etc.
 | BUDGET SOURCE |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ESTIMATE OF COMPENSATION
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ** Faculty Status - do not complete  Est. Hrs. Worked
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | and Hourly Rate / Hr.  Enter amount in Est. Compensation
 | Account No. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | field.
 | Account Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ** Electronic Learning - Internet or Web Based Course
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | A faculty who develops and initiates an internet or web-based course will receive $1,000.  Enter this amount in Est. Compensation field.
 | PAYMENT OF EARNED COMPENSATION
 | (Complete FORM B) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Est Hours Worked
 | A check Request for Supplemental Pay Compensation is  required to authorize Payroll to process payment.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Hourly Rate / Hr.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Attach a written justification for hourly rate.
 |  |  |  |  |  |  |  |  | ` |  |  |  |  |  |  |  |  |  | Est Compensation
 | 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
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Director / Research / Date |  |  |  |  |  |  |  |  |  |  | [NAME]
 | Employee's Signature / Date |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Vice President / Date |  |  |  |  |  |  |  |  |  |  | President / Date
 | CC:   Department Head, Human Resources, Academic Affairs, Research, Payroll, Board Material