University of Massachusetts Dartmouth

University of Massachusetts Dartmouth Approval Form - Additional Compensation (Stipends) for Temporary Duties Professional Employees Engaged in Non-Instructional Activities

Name of Employee Department

Dates services to be performed: From To

Total Amount Requested $ Bi-weekly Amount $ OR Hourly Rate $ Amount Allocated Through June 30th $ $ Amount Allocated From July 1st To End Date $ Total $ Amount Allocated $ HR Acct Code Proj/Grant No: How did you arrive at this amount?

Detailed Description of Work to be Performed:

Is this work outside of the scope of current responsibilities substantial increase of current duties If outside the scope, please give a detailed explanation of why you have made this determination.

Does this work fall within the scope of another employye’s current responsibilities? Yes No If yes, what is the reason they are not being performed by that employee?

If a substantial increase, please give a detailed explanation of what measures were used to make this determination.

Work that is a substantial increase must be done outside of normal work hours. Who will monitor this?

What is the impact on the University if these services are not performed?

Other Additional Compensation: Do you anticipate other additional compensation for this employee from any other sources? Effective Date End Date Bi-weekly Amount Total Amount

Supervisor

Funding Department (if Different from Supervisor)

Dean/Director/Department Head Director HR

Vice Chancellor:

Fiscal Payroll