Application to Undertake Private Consulting Activity

Name of Faculty Member:_______________________________________________________

Name of Client:_______________________________________________________________

Nature of Outside Activity:______________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Time Period of Outside Activity:_________________________________________________

Estimated Amount and Distribution of Time to be Spent on Outside Activity:_______________

___________________________________________________________________________

_______________________________________      __________________________
Signature                                          Date
 
__________________________________     _______________________
Approval Signature (Department Head)                                            Date
 
_______________________________________            __________________________
Approval Signature (Division Director)                                           Date
 
_____________________________________                 __________________________
Approval Signature (President)                                                         Date