Instructions: This form contains fillable boxes. Save the file, enter all information electronically, save the file, and then print the file. Send a print or electronic copy to Debbie Himmelberg in the Provost’s Office (dhimmelb@centralmethodist.edu). Date Full Name of Adjunct Faculty Adjunct Faculty ID Number Address Telephone Home Work City, State, Zip Cell Charge to (campus/site) Is Curriculum Vita/Résumé on file with Charge to (account) Division Chair? Is Curriculum Vitæ/Résumé on file with Office? Course # Credit Course Title Meeting Days Meeting enrollment pay Hours Time Semester/Term & Year Special Agreements/Arrangements Requested Response to Special Request Provost’s Salary Requested $ Salary Granted $ Payable in equal monthly installments beginning Payable at the end of the semester/term Person Completing Request Form Completer’s Signature____________________________________________ Official Use Only Notification Sent to Office (Date) President’s Confirmation Sent by Office to Adjunct Faculty (Date) President’s Confirmation Copy Sent to (Date) Provost’s Office
Instructions: This form contains fillable boxes. Save the file, enter all information electronically, save the file, and then print the file. Send a print or electronic copy to Debbie Himmelberg in the Provost’s Office (dhimmelb@centralmethodist.edu). Date Full Name of Adjunct Faculty Adjunct Faculty ID Number Address City, State, Zip Telephone Home Work Cell Charge to (campus/site) Charge to (account) Is Curriculum Vita/Résumé on file with Division Chair? Is Curriculum Vitæ/Résumé on file with Office? Course # Credit Hours Course Title Meeting Days Meeting Time enrollment pay Semester/Term & Year Special Agreements/Arrangements Requested Provost’s Response to Special Request Salary Requested $ Salary Granted $ Payable in equal monthly installments beginning Payable at the end of the semester/term Person Completing Request Form Completer’s Signature____________________________________________ Official Use Only Notification Sent to President’s Office (Date) Confirmation Sent by President’s Office to Adjunct Faculty (Date) Confirmation Copy Sent to Provost’s Office (Date)