Adjunct Request Form

Adjunct Request
Adjunct requests require review and approval from your college dean's office as well as the Office of the Provost. Please submit requests with ample lead time for all approvals.
Your Name

First NameLast Name
Your Email
Provide your @wiu.edu email address
College
CBHCP School
CHASE School
Area
Accounting and Business Administration Program
Agriculture Program
Applied Clinical, Educational, and Professional Program
Communication, Media, and Experience Industries Program
Computing, Data, and Mathematical Sciences Program
Education Program
Engineering and Technology Program
Humanities Program
Law Enforcement and Justice Administration Program
Natural Sciences Program
Nursing, Applied Health, and Human Performance Program
Social Sciences Program
Visual and Performing Arts Program
Deans Office Approver
- Semester
- Year
- Adjunct Name
  
  First NameMiddle NameLast Name
- Adjunct Type
- Preferred First Name
  If they go by a nickname
- Birth Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Adjunct's WIU ID
- Adjunct's WIU email address
- Personal (Non-WIU) Email Address
  Must not be a @wiu.edu email address.
- Home Phone Number
  Format: (000) 000-0000.
- Mailing Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- WIU Phone Number
  If applicableFormat: (000) 000-0000.
- WIU Building and Room Number
  if applicable
- Describe most-recent employment history at WIU. Include date of most recent employment.
- Total Anticipated Adjunct Expense
  NOT monthly. Provide TOTAL expense.
- Please explain how the above total was calculated.
  Note: any amount over $1208 per ACE MUST be justified.
- Please upload the adjunct's CV
  
  PDF, DOC and DOCX formats accepted
  Cancelof
- Courses This Adjunct Will Instruct
- How Many Courses Will This Adjunct Instruct?
- If this adjunct will instruct more than four (4) courses, please contact the Office of the Provost for guidance before submitting this form.
- Course 1
- Course Prefix
  e.g. ACCT
- Course Number
  e.g. 200
- Course Title
  e.g. Introduction fo Accounting
- Session
  If "Other", clarify start/end dates in comment field at end of form
- Delivery Format
- Current Enrollment
- Anticipated Enrollment
- Course Justification
  e.g. elective, required for graduates, teach out, etc
- Credit Hours
- Aces Assigned for the Course
- Course 2
- Course Prefix
  e.g. ACCT
- Course Number
  e.g. 200
- Course Title
  e.g. Introduction fo Accounting
- Session
  If "Other", clarify start/end dates in comment field at end of form
- Delivery Format
- Current Enrollment
- Anticipated Enrollment
- Course Justification
  e.g. elective, required for graduates, teach out, etc
- Credit Hours
- Aces Assigned for the Course
- Course 3
- Course Prefix
  e.g. ACCT
- Course Number
  e.g. 200
- Course Title
  e.g. Introduction fo Accounting
- Session
  If "Other", clarify start/end dates in comment field at end of form
- Delivery Format
- Current Enrollment
- Anticipated Enrollment
- Course Justification
  e.g. elective, required for graduates, teach out, etc
- Credit Hours
- Aces Assigned for the Course
- Course 4
- Course Prefix
  e.g. ACCT
- Course Number
  e.g. 200
- Course Title
  e.g. Introduction fo Accounting
- Session
  If "Other", clarify start/end dates in comment field at end of form
- Delivery Format
- Current Enrollment
- Anticipated Enrollment
- Course Justification
  e.g. elective, required for graduates, teach out, etc
- Credit Hours
- Aces Assigned for the Course
- Please provide any additional information you feel is necessary to include with this request.
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