Administrative Role Supplement Request

Administrative Role Supplement Request

Type of Request*

Select or enter value

Change Request

Select or enter value

Department*

Select or enter value

Other Department(School)

Division

Faculty Name*

Last Name, First Name

Line*

Select or enter value

Rank*

Select

Role Title*

Official Title of Administrative Role

Requested Start Date*

When selecting a start date it should be the date that the duties associated with role begin. Please keep in mind that Administrative roles need to be approved by Faculty Compensation, the Vice Dean and for Professoriate also the Provost.

Description of Role*

Include a brief description of the duties associated with the role. If the role is temporary please indicate the length of time.

% of Effort Associated with Role*

New effort allocation. Must equal 100%*

Include the new breakdown of duties, i.e. %clinical, %research, %teaching, %administration

Compensation Associated with Role

Select

Compensation Type

Administrative Supplements are paid every pay period.

Leadership incentives are paid quarterly or annually

Select

Proposed Annual Supp/Leadership Inc Amount*

Change Proposed Amount

Enter the full amount of the new supplement being proposed.

Change Proposed Title

Change to Duties

End Date

Description of Change Request*

Include a reason for the change and any special comments for Faculty Compensation

Department Contact for Follow Up Questions*

Documentation

Please attach an OLA and PAF for the new role. If it hasn't been created yet, we will request it again once the role has been approved.

File Upload

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