Special Consultant - Request For Payment Form
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1UNIVERSITY CORPORATION, SAN FRANCISCO STATE
PO Box 320160
San Francisco, CA 94132
SPECIAL CONSULTANT - REQUEST FOR PAYMENT
Fund #
Dept. #
Date of Request:
(required)
Project Phone #:
Project Contact:
Mail to payee’s address
Hold / Call for pick up Ext
Check Distribution:
MAKE CHECK PAYABLE TO:
Name:
UIN #:
Address / City / State / Zip:
DOB:
(required)
Amount of Payment Requested:
Service(s) performed: *
Date(s) (required)
Total hours (required)
*Are you receiving additional campus compensation (state or non-state funded) during the appointment period?
YES
NO
if yes, please describe:
***Attach a detailed Job Description of duties (to be) performed – Required before payment processed
If you have not been previously paid as an employee or Special Consultant through the UCorp – you are
required to complete an I-9 and W-4 in the presence of a UCorp representative.
Is Special Consultant employed by SFSU?
YES
NO**
FERP’ing
** If NO, another form of compensation is likely appropriate. Retired Faculty are not employed at SFSU.
Contact our Program Manager for further assistance at x8-7920
If YES, consultant is:
Faculty
Staff
Emp Status:
Exempt
Non-exempt
0%
If not full-time, % of time worked:
SFSU employment full-time?
YES
NO
If yes to full-time faculty, is work same / similar to current SFSU work?
YES If yes, ineligible
NO
AUTHORIZATION REQUIRED FOR EMPLOYEES OF SFSU PRIOR TO WORK BEING PERFORMED
SFSU Vice-President:
SFSU VP - signature:
SFSU HR- Authorized by:
SFSU HR – signature:
Project Directors Approval:
Date:
Received by UCORP:
Allowance approval:
Admin/Finance approval:
Payroll Processing:
Date:____________
By:___________
By: _____________
By:____________
EE # ____________
Tax:__________
Date: ____________
Date:___________
W/C: ____________
Subcode: 601933
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