Date: Complete form (online) Print Modification of Reduced Responsibility Status Obtain signatures . Send to: Reduced Responsibility policy: Department Chair and Submission Instructions Administrator Faculty Information Faculty Name Faculty EID Faculty Title Primary Department/Program & College/School/Campus Secondary Department/Program & College/School/Campus (joint appointment) Effective Date % Appointment FTE (full-appointment) 9 month 12 month Modification: Changes to Distribution of Responsibilities DURING RR Status Period Institutional Base Source of Funding IBS Source(s) of Funding Salary (UW Budget #) (% Responsibility) (UW Budget #) (% Responsibility) with RR Status IBS (Monthly full-time rate) Salary Distribution Grant A Grant B Institutional Scholarly activities (e.g., grant writing, teaching, clinical, service, ADS, ENS) Total Paid Monthly IBS Authorization Faculty Signature Date Chair/Director(s) Signature Date Dean/Chancellor(s) Signature Date
Date: Submission Instructions Complete form (online) Print Obtain signatures Send to: Department Chair and Administrator Modification of Reduced Responsibility Status . Reduced Responsibility policy: Faculty Information Faculty Name Faculty EID Faculty Title Primary Department/Program & College/School/Campus Secondary Department/Program & College/School/Campus (joint appointment) Effective Date % Appointment FTE (full-appointment) 9 month 12 month Modification: Changes to Distribution of Responsibilities DURING RR Status Period Institutional Base Salary (% Responsibility) Source of Funding (UW Budget #) IBS (% Responsibility) with RR Status Source(s) of Funding (UW Budget #) IBS (Monthly full-time rate) Salary Distribution Grant A Grant B Institutional Scholarly activities (e.g., grant writing, teaching, clinical, service, ADS, ENS) Total Paid Monthly IBS Authorization Faculty Signature Date Chair/Director(s) Signature Date Dean/Chancellor(s) Signature Date
modification-to-rr-status.docx