Spreadsheet: 05c2c318-832f-4a20-96a7-b857c167d7c5
Sheet: Form

NAME: |  |  | Enter Employee Name
EMPLOYEE TYPE: |  |  | Enter EPA/EPA-NF/SPA
CURRENT RANK/TITLE/SPACLASS TITLE: |  |  | Enter Rank/Title
NEW RANK/TITLE: (If applicable) |  |  | Enter New Rank/Title if appicable
SCHOOL/DIVISION & DEPT: |  |  | Enter School/Division
REASON FOR INCREASE: |  |  | Enter Reason for Increase
PROPOSED EFFECTIVE DATE: |  |  | Enter Date
[NAME] 30th BASE SALARY: |  |  |  | Enter $$$
JUNE 30th STIPENDS/SUPPLEMENTS/TEMP
 | ASSIGNMENTS (do not include lump sum pymnts): |  |  | Enter $$$ |  | If not applicable, enter "0" in currency field
JUNE 30th TOTAL SALARY:
 | Source(s): | State: |  | Enter $$$ | Note:  Sources of Non-State Funds are usually grants, trust funds, endowments, medical faculty practice plan, etc.
 |  | Non-State: |  | Enter $$$
 | Source of Non-State Funds:
CURRENT BASE SALARY: |  |  |  | Enter $$$ | PERCENTAGE OF INCREASE  TO BASE:
TOTAL CURRENT TO DATE STIPENDS/ |  |  |  |  | AMOUNT OF INCREASE  TO BASE:
SUPPLEMENTS /LUMP SUM PAYMENTS/
TEMP ASSIGNMENTS:
(post-June 30th cumulative) |  |  |  | Enter $$$ | AMOUNT OF INCREASE  TO STIPEND:
CURRENT FTE |  |  |  | Enter #
CURRENT TOTAL SALARY: |  |  |  |  | TOTAL PERCENT OF SALARY INCREASE:
 | Source(s): | State: |  | Enter $$$
 |  | Non-State: |  | Enter $$$
 | Source of Non-State Funds:
RECOMMENDED BASE SALARY: |  |  |  | Enter $$$ | PERCENTAGE OF INCREASE  TO BASE:
RECOMMENDED STIPENDS/SUPPLEMENTS /LUMP SUM PAYMENTS/TEMP ASSIGNMENTS: |  |  |  |  | AMOUNT OF INCREASE  TO BASE:
(post-June 30th cumulative) |  |  |  | Enter $$$ | AMOUNT OF INCREASE  TO STIPEND:
NEW FTE |  |  |  | Enter # | AMOUNT OF INCREASE DUE TO FTE
RECOMMENDED TOTAL SALARY: |  |  |  |  | TOTAL PERCENT OF SALARY INCREASE:
 | Source(s): | State: |  | Enter $$$
 |  | Non-State: |  | Enter $$$
 | Source of Non-State Funds:
TOTALS: |  |  | TOTAL PERCENTAGE OF BASE INCREASE FOR FISCAL YEAR:
 |  |  | TOTAL AMOUNT OF BASE INCREASE FOR FISCAL YEAR:
 |  |  | TOTAL AMOUNT OF STIPEND/SUPPLE. INCREASE FOR FISCAL YEAR:
 |  |  | TOTAL PERCENTAGE INCREASE FOR FISCAL YEAR:
 |  |  |  | TOTAL INCREASE AMOUNT FOR FISCAL YEAR:
 |  |  |  |  |  |  | (IF APPLICABLE) TOTAL PERCENTAGE INCREASE FOR FTE CONVERSION:
 |  |  |  |  |  |  | (IF APPLICABLE) TOTAL INCREASE AMOUNT FOR FTE CONVERSION:
 |  | BOT APPROVAL  REQUIRED |  |  |  | BOG APPROVAL REQUIRED
THE RECOMMENDED SALARY INCREASE IS APPLIED TO THE (SELECT ONE): |  |  |  |  | Select One (drop down)
 |  | REASON CODE (SELECT ONE): |  |  | Select One (drop down)
JUSTIFICATION:Enter brief justification here (PLEASE NOTE IF THE INCREASE IS TO THE BASE SALARY OR IS AN INCREASE TO THE STIPEND/SUPPLEMENT/LUMP SUM PAYMENTS/TEMPORARY ASSIGNMENTS). Note: Any EPA increase 10% or greater requires BOG approval, must attach memorandum on official letterhead addressing justification specifics.
Employee Name:
Proposed Effective Date of Increase:
APPROVALS:
Department / Center Head Approval:
 |  |  |  | (Type Name) |  | (Type Title) |  | Date
[NAME]/Vice Chancellor Approval:
 |  |  |  | (Type Name) |  | (Type Title) |  | Date
VC OHR/EVC & Provost approval (when required):
 |  |  |  | (Type Name) |  | (Type Title) |  | Date
Department Certification:
 |  |  | Prepared by:
 |  |  |  | (Type Name) |  | (Type Title) |  | Date
 | To be completed by originating unit:
 | By checking this box, the preparer certifies that all existing insitutional policies and procedures for
 | for employment decisions have been followed (i.e.,tenure and promotion process, employment approvals, UNC code compliance,
 | OSP compliance)
 | To be completed by Dean's Office:
 | By checking this box, the preparer certified that the appropriate [NAME] and [NAME], Vice Chancellor or designee have approved this
 | request. If 20% or greater there are no designees and request must be approved by the relevant [NAME] or Vice Chancelllor.
 | To be completed by OHR or Provost's Office as appropriate:
 | By checking this box, the preparer certifies that the Chancellor or the Chancellor's designee have approved this request.
 | OHR Use Only
 | Submission Instructions:  For SPA Promotional Increases: Send this form to your OHR Employment Consultant For All Other SPA Increases: Send this form to your OHR Classification and Compensation Consultant For EPA Non-Faculty Increases: Email this form to the EPA Non-Faculty HR unit at [EMAIL] For Faculty Increases: Email this form to the Academic Personnel Office at [EMAIL]; call 962-1091 with any questions.