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.)

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________

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________________________