Staff Teaching Request Form

Fields marked with an * are required

Authorization text

Authorization must be obtained each semester staff member is teaching.

Name of Staff *

Home Department *

Requesting Academic Program *

Name of Course *

Course Semester(s) *

Course Code *

Course Day(s)/Time *

Number of hours for course *

Overload Pay? *

For nonexempt employees, will this assignment create an overtime pay situation? *

Will assignment change benefit eligibility? *

Justification for staff being the only available option and plan to ensure temporary assignment: *

This has been approved by the employee's home department *

Home Department Supervisor signature (enter name to sign) *

This has been approved by the Academic Department Chair *

Academic Program Chair Signature (enter name to sign) *

Submitter's Email Address *

New Student Portal +