Yale

SCHOOL OF MEDICINE

Faculty Compensation Above Salary Request Form

Faculty members in the School of Medicine may be paid for additional work such as on call pay, pay for additional shifts, lectures delivered to affiliated organizations or for taking on additional duties on an interim basis. Prior approval to pay defined, additional compensation in these circumstances must be obtained before this type of work is performed. For components that are defined in a department’s compensation plan, approval of the compensation plan serves as the prior approval. In all other cases, prior approval must be obtained from the Dean’s Office.

This form is to be used to request faculty compensation above salary for any arrangements that are not captured in a department’s defined additional compensation plan. Prior approval for the arrangements must be obtained before an assignment begins.

Submitter's Name

Submitter's Email

Status

Faculty Home Department

Faculty Request Department (if different from Faculty Home Department)

Faculty Member

Position/Rank

Provide Position/Rank if Other

In the space below, please provide a comprehensive description of the work to be performed

In the space below, please provide the basis for determining the payment amount

In the space below, please provide when pay should be received

Additional Compensation Amount $

Anticipated start and end date of work:

Start

End

Will this payment be charged to a sponsored award?

YesNo

If yes, please attach the confirmation of OSP's review. In addition, include the section of the proposal budget and budget justification submitted to the sponsor that identifies the individual and their role on the project. If the compensation was not detailed in the original budget/justification, then attach approval from the sponsor for the compensation.

Request is being processed.