Faculty Adjunct Contract Form/cgu Faculty Overload Form
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1Claremont Graduate University
FACULTY ADJUNCT CONTRACT FORM/CGU FACULTY OVERLOAD FORM
If you have any questions or need help filling out this form, please e-mail: ProvostAdmin@cgu.edu. All contract request forms and curriculum vitae
must be submitted to the Office of the Provost by inter-campus mail. After the adjunct professor has returned the signed contract letter to the Provost’s
Office, a copy will be sent to you for your records. Please make sure the adjunct professors in your school/department return the letter signed. If the
course is cancelled, please send an e-mail to
rose.perez@cgu.edu
(Payroll) and
ProvostAdmin@cgu.edu
(Provost Office).
DEADLINE DATES: Fall- July 1; Spring- November 1; Summer- April 1.
CONTRACT INFORMATION
Center/School:
Program:
Semester:
Year:
Dean of School/ Authorized Signature:
Contact Person & Extension:
Date form competed & submitted:
PERSONAL INFORMATION
Dr.
Ms.
Last Name:
First:
Middle:
Mr.
Mrs.
Date of Birth
US Social Security Number:
Gender:
Male
Female
(MM/DD/YY):
No
Needs Assistance
Citizenship:
US Citizen
US Permanent Resident
International, Visa Type:
with Visa:
Yes
CONTACT INFORMATION
PERMANENT ADDRESS
Street Address:
Apartment/Unit #
City:
State:
ZIP:
Country:
MAILING ADDRESS (if different from above)
Street Address:
Apartment/Unit #
City:
State:
ZIP:
Country:
ADDITIONAL CONTACT INFORMATION
Phone Number:
E-mail Address:
EMERGENCY CONTACT INFORMATION
Contact Name:
Phone Number:
Address:
COLLEGE AFFILIATION
Please check the
Claremont Colleges faculty (not
Affiliated member at institution
CGU faculty
appropriate box (if
including adjuncts or visiting)
outside the Claremont Colleges
Teaching overload
applicable):
College: _________________
Institution: _________________
CGU student
COURSE INFORMATION
(IF APPLICABLE)
14 Digit Account #
Module
Start Date
End Date
(adjunct: 4060; CGU
Units
Course Number and Name
Salary
(if summer)
(MM/DD/YY)
(MM/DD/YY)
faculty 4061; summer
4070 or 4071)
I
II
I
II
I
II
REIMBURSEMENTS
Airline Ticket
Hotel
Transportation
Meals
Account Number ________________________
SPECIAL WORDING FOR CONTRACT
(IF APPLICABLE)
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