SUPPLEMENTAL/CONSULTANT SERVICES PAYMENT REQUEST
I.  SERVICES RENDERED
NAME				SS#
ADDRESS		CITY		STATE		ZIP

PROJECT TITLE

BUDGET CODE

SERVICES PROVIDED WERE

DATE(S): FROM	TO	* NEW employees must complete I-9 for in Personnel before being paid.

II.  BUDGET SUMMARY

(If this project is supported through outside funds, the service must have been approved in the internal budget).

1) Number of hours or x proposed or rate of =	$
2) Travel (attached explanation and subject to EKU travel policy)	$
3) Per diem (not to exceed state regulations and subject to EKU travel policy)	$
4) Other	$
5) TOTAL	$

III.  EKU EMPLOYEE	I certify that a REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT FORM was approved on and that the requested consultant services will not exceed EKU policy regarding cumulative weekday consultant hours claimed/paid. (FACULTY/STAFF HANDBOOK: Outside Activities.)
	Signature	Date

IV.  APPROVED
Project Director (If appropriate)		Date	OR
Budget Unit Head		Date
Graduate Dean (Required for GAs only)		Date
***********************************************************************************
This request is in accordance with the approved budget and funds are available.
Division of Accounts:		Date	OR
	(Grants/Contracts & Special Programs Funds)
Vice President for Financial Affairs:		Date	OR
	(Other Funds)