a. Complete Section I and if over $500 forward to the Director of Human Resources for approval prior to event.
b. Complete Section II upon completion of lecture.
c. Is the Presenter/Lecturer a current SFSU employee?
__Yes – Submit completed form to Human Resources.
__No – Submit completed form to Accounts Payable.
(Include a Vendor Data Record form or check cannot be issued.)
3. Date, time and location of event___________________________________________
4. Describe event and purpose for Honorarium_________________________________
5. Presenter/Participant/Recipient Name __________________________________
6a. If for an individual NOT an SFSU employee, provide account #:_______
6b. If for an SFSU employee, provide appropriate position #:
Agency_____ Unit _____Job Code _______ Serial No. _____
PS Employee ID#:_______________________ Empl. Rec #:___________
Payment Charge to:__________________ ____________ ____________ ____________ ____________
Account (6) Fund (5) Dept ID (4) Class (2) Project ID# (8)
7. Amount: $__________________________
8. I CERTIFY that the services listed are necessary to the sponsored activity and that there are sufficient funds available for this transaction.
9. Director of Human Resources (if over $500) Associate Vice President, ORSP (if applicable)
Approved:_______________________ Date________ _______________________ Date________
10. INVOICE for services rendered:
I certify that I have completed the services as described in Section I, and I request payment in the amount indicated above
as payment in full for services rendered. I ___ am ___ am not a current University employee.
Signature of Presenter/Participant/Recipient___________________________________ SSN#____________________
11. __Hold check for pick up at the Disbursement Office (Administration 351).
__Please mail check to: (must be typed or printed)
Name of Presenter/Participant/Recipient______________________________________________
City_________________________________ State/Zip_________________ Phone #________________
12. I certify that the above services have been satisfactorily completed.
Signature of Dean/Director:___________________________________ Date________________________
Budget verification for ORSP (if applicable):_______________________ Date________________________