PRACTICE DIRECTIVE P301A
HONORARIUM PAYMENT REQUEST
10/2000 Rev. 09/2005

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INSTRUCTIONS TO ORIGINATOR:

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.)

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SECTION 1:

1. College________________________________________________________________

2. Department/Project____________________________________________________

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.

Dean/Director_________________________________ Date__________________

9. Director of Human Resources (if over $500) Associate Vice President, ORSP (if applicable)

Approved:_______________________ Date________ _______________________ Date________

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SECTION II:

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______________________________________________
Address________________________________________________________________
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________________________