Name of the Assistant: E # :
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

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

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