Part I: Supplemental Contract Offer Completed by Offering Unit

Name of the Assistant: Social Security # : Department/Unit Offering the Supplemental Contract: Brief description of supplemental duties and how supplemental duties are different from regular duties: Brief description of specialized expertise: Have other supplemental contracts been accepted during this same term/year? No Yes Date(s) of the supplemental work: Total number of clock hours of supplemental contract: Compensation: $ total to be paid in installments. Supplemental account payment # : Account name: ____________________________________________________ Date: Supplemental Offer Fiscal Agent's Signature

Part II: Approval of the Home/Department Unit

Assistant's home department/unit: Brief description of regular duties: Home department/unit supervisors decision: I approve the supplemental contract I do not approve the supplemental contract for the following reasons: ____________________________________________________ Date : Home Department/Unit Signature

Part III: Approval of the Graduate School

Graduate Dean's Decision: I approve the supplemental contract I do not approve the supplemental contract for the following reasons: ____________________________________________________ Date: Graduate Dean's Signature