GUEST LECTURER FORM

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					                          GUEST LECTURER FORM

(1) Check your class budget FIRST, if you wish to pay the guest lecturer an honorarium.

(2) After completing the top of the form, please return it to the department Chairperson
for approval.

(3) The bottom portion of the form should be completed and signed by the
Guest Lecturer. A home address and Social Security number must be
given for payment to be made.

(4) Return Completed form to: Vickey Webster

NOTE: The top portion should be completed for each Guest Lecturer even if payment is
not to be made.

_____________________               _________               _________________
Name of Guest Lecturer              Class                   Date of Appearance

Topic to be presented:

Brief statement of qualification of Guest Lecturer:

If honorarium is to be given:         Amount____________

APPROVAL: ____________________________                DATE:_________

CHAIR:_________________________________               DATE:_________
*************************************************************
If honorarium is requested the following must be completed by Guest Lecturer and
returned to Vickey Webster, 142 WALKER HALL

Is Guest Lecturer a U.C. Employee? No___ Yes___ If yes, where?_______

Social Security Number______________________________

Home Address:_____________________________________

               _____________________________________
       Phone#_____________________

__________________________            __________________
Signature Guest Lecturer                    Date

				
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