Outside Employment Approval Request

Reporting Period

July 1, 2024 through June 30, 2025 (while employed full-time). This requirement does not apply to employees who are not on contract in the summer. However, if the outside employment extends from the summer into the fall semester, this form must be submitted. NOTE: Approval of outside employment must occur before the employment begins.

WIU/UPI 2023-2026 Agreement, Articles 18.16 [Unit A] and 32.3 [Unit B]

Outside employment projected state date:*

Start date

Outside employment projected end date:*

End date

Anticipated time commitment (avg. number of hours per week):*

In the case of consulting activities, limited to no more than 20 percent of an employee's work time (example: in a five-day week, an employee is limited to one day of consulting).

Describe the outside employment (e.g., self-employment, type of business, name of employer, nature of personal responsibilities, on-going consulting contract, etc.). Examples of activities for which you need not submit a form: teaching classes through WIU's sponsored credit, royalties, honoraria for occasional presentations, one-time or occasional stipend for a professional consultation or review of a textbook, manuscript, or other such items.*

Faculty/Employee Name*

First NameLast Name

Your Email*

example@wiu.edu

Your unit*

Your unit described by the WIU/UPI Agreement

Department/School*

What is the title of your area

Your direct supervisor's WIU email address*

Generally this is your department chair. An approval email will be sent to this address. ENSURE THAT THE EMAIL ADDRESS IS CORRECT.

Your college dean's/VP's WIU email address*

If approved by your supervisor, a secondary approval email will be sent to this address. ENSURE THAT THE EMAIL ADDRESS IS CORRECT.

Signature*

I attest that the projected outside employment does not represent a potential conflict of interest with and/or commitment to Western Illinois University.

Instructions for Final Reporting (If required, you will be notified by email from the Provost's Office to submit a final report)

Final Reports are Due July 31 (one month following fiscal year end)

Following the completion of the year for which the Outside Employment form was submitted, employees performing the outside research or consulting services must submit a statement of the amount of actual time they spent on such outside research or consulting services. This statement is a separate document from the Request for Approval form and is mandated by the Illinois General Assembly Public Act 76-1343. To comply with this mandate, please send a brief report (no required format) of the outside employment you completed in writing or via e-mail to Amy Hodges (AD-Hodges@wiu.edu) by July 31. Please identify the reporting fiscal year and include 1) a brief description of the outside activity/employment in which you were engaged and for which you received compensation, 2) the dates of the activity/employment, and 3) the actual amount of time spent. This report should be completed by all persons who performed outside employment.