Academic Year Additional Compensation Form (For Academic Year Faculty Only)
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Academic Year Additional Compensation Form
(for Academic Year Faculty only)
EmplID
Rcd
EmplID ______________ Rcd ___
University of Massachusetts – Amherst
This form is to be used to grant approval for participation in and payment of additional compensation for faculty. The Additional Compensation Policy
(T01-12) and Amherst campus guidelines appear on the reverse side of this form. Submit the completed form to the Division of Human Resources.
SECTION A: To be completed by the Funding Department
Employee Name ______________________________________________________
Faculty Title
______________________________________________________
Home Dept Name ______________________________________________ Funding Dept Name __________________________________________
Appointment Period From ______________________ To ___________________
Total Recommended Ad Comp
$
$
Recommended Bi-Weekly Ad Comp ________________ X _________ = Recommended Total Ad Comp ___________________________________
# of biweekly
payperiods
$
Current Annual Salary (FTE) ___________________________
Type of Funds:
Type of Funds:
Funding:
HR Combo Code ______________________ Fund _______________
Federal/State Grant/Contract*
Federal/State Grant/Contract*
NSF *
Dept ID
______________________
Project/Grant _______________________
NSF*
Private Grant/Contract **
Private Grant/Contract **
Other
Other
_________________________________________________
Principal Investigator Signature
*
Additional compensation funded by federal sources is only allowed in unusual circumstances for consultation across departmental lines if work is
performed in addition to regular department load and such agreement is specifically provided for in the agreement or approved in writing by the
sponsoring agency (attach copy of award page).
** Faculty may only receive additional compensation from private sources when no effort is budgeted or charged to federal or state grants and
contracts during the academic year. (Attach copy of award page)
Description of Services:
APPROVED BY:
___________________________________________ ______________
____________________________________________ ________________
Department Head/Director
Date
Dean/Vice Chancellor
Date
Form Prepared by: _________________________ Email ______________________________ Phone ______________ Date _______________
Name
SECTION B: To be completed by the Home Department
Additional Compensation for this faculty member is:
APPROVED
DISAPPROVED
___________________________________________ _____________
___________________________________________ _________________
Department Head/Director
Date
Dean/Vice Chancellor
Date
SECTION C: To be completed by Human Resources and Controller’s Office
HR USE ONLY
CONTROLLER USE
Acct Cd
Amt
Date
By
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