Request for Supplemental/ Overload Pay
Instructor
__________________
Semester ___________
Course # |
Course Title |
Credit hours |
||
|
|
|
|
||
|
|
|
|
||
|
|
|
|
||
|
|
|
|
||
|
|
|
|
||
|
|
|
|
||
|
Directed
Study |
Short
title |
#
hrs |
#
stds |
#hrs
x
#stds / 6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Internships |
Short
title |
#
hrs |
#
stds |
#hrs
x
#stds / 6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total hours =__________________
- Hours in contract =__________________
- Hours donated =__________________
= Hours reimbursed =__________________