Contractor Independent

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					The University Corporation                                                                                                                                            18111 Nordhoff Street
                                                                                                                                                                      Northridge, CA 91330-8309
Request for Independent Contractor                                                                                                                                    Phone: (818) 677-3061
                                                                                                                                                                      Fax: (818) 677-3017

Independent Contractors are defined as individuals who are not affiliated with the University or The University Corporation, and are        Please submit Request for Independent Contractor
in business for themselves to provide services. Excluded from being Independent Contractors are companies, employees (incl.                  at least two weeks prior to the expected dates of
Student or Grad. Assist.) of CSUN, TUC or any other CSUN auxiliary, and federal government employees.                                                          the services.

                                                                                                                                                Agreement Number
1. Independent Contractor                                                                                                                        (will be assigned by TUC)
                                                                                                                                     This agreement number must appear on all documents,
                                                                                                                                              invoices, and all correspondence!

    Social Security Number:

2. Cost Allocation
    Account                               Fund                                       Department                            Project                           Amount
    Account                               Fund                                       Department                            Project                           Amount

3. Dates Of Service
    The dates the services are to be performed are from                                                                                    to

4. Services To Be Performed

5. Compensation
                              Rate                                                            # Time Base                               Amount
    Rate-Based:          $           -        Per hour        X # of hours                        0.00                     $                           -
                         $           -        Per week        X # of weeks                        0.00                     $                           -
                         $           -         Per day        X # of days                         0.00                     $                           -
                         $           -      Per minute        X # of minutes                      0.00                     $                           -
    Other Base:         Please explain!
                                                                                                                            $                          -
    (e.g. Increments)
                                                                                       Total Contract Amount: $                                        -

4. Requestor
    Requested By:                Name:
                             Mail Drop:                                                 Valid Signature Authorization(s)
                                                                                            must be on file at TUC !
                                E-Mail:                                                                                                               (Signature)

5. Budget Verification/Approval (To Be Completed By The University Corporation)

     TUC-Sponsored Programs:                                                Name:

     TUC-CFO:                                                               Name:
    Instructions To Requestor                                                        4) Attach bids or sole source justification if applicable (see TUC Purchasing Policy)
    1) Complete request with all detailed information                                5) Mail the original with attachments to TUC, Mail Drop 8309
    2) Form must be signed with authorized signature on file at TUC                  6) You may want to keep one copy for your own records
    3) If applicable, attach required supporting documentation                       7) If you have any questions, please call extension 3061 or 4695
                                                                                                                                                                Request for Independent Contractor - Version 07-0305

Description: Contractor Independent document sample