NAME (Please Print): ____________________________________________________
NAME & ADDRESS OF ORGANIZATION: _______________________________________
DESCRIPTION OF OUTSIDE ACTIVITY:
(Be as complete and specific as possible; attach sheet, if additional space is required).
__________________________________________________________________________
__________________________________________________________________________
1. Would this outside activity involve compensation over and above out-of-pocket expenses? YES NO
2. CLASSROOM SUBSTITUTION: Circle one:
1. No classes would require substitute instruction.
2. Substitute instruction would be required in the following classes (list course number, hour, and location along with substitute instructor’s last name):
_______________________________________________________________
The alternative arrangement for covering these classes have been approved by the Department Chairperson in a memorandum on file in the department.
3. TIME PERIOD AND AMOUNT OF TIME REQUIRED FOR OUTSIDE ACTIVITY:
This activity would begin ____________ and end ____________ and involve: _______ (hours or days)
My engagement in this outside activity will not interfere with the regular and punctual discharge of my official University duties and responsibilities.
____________________________________________________
Signature of faculty member requesting approval _______________
Date
RECOMMENDED / NOT RECOMMENDED
____________________________________________________
Dean, College of Law
_______________
Date
Revised 5/20/94
