Request for Additional Compensation
(Complete form and secure approval IN ADVANCE of services being rendered)

I    Employee Information

Name:   _____________________________________________________________________
Title:     _____________________________________________________________________
Home Department:   ________________________________    Current FTE:   _______________
Department Requesting Service:   __________________________________________________
Amount of Additional Compensation: ___________________

II.    Description of Services _______________________________________________________
        __________________________________________________________________________
        __________________________________________________________________________
        __________________________________________________________________________

When is service to be performed:

Dates:          From ____________    To ____________

III.    Approvals

________________________________________________        _______________________
Home Department Supervisor                                                             Date

_________________________________________ _______       _______________________
      Requesting Department Supervisor                                                           Date

________________________________________________        _______________________
      Human Resources                                                                                         Date

________________________________________________        _______________________
      Budget Committee *                                                                                     Date

* Total request that equal more than one week’s wage in a fiscal year must be approved by the Budget Committee

Addendum to Request for Additional Compensation signed by employee must also be attached to this form.