Contractor Requisition Form

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Contractor Requisition Form

Contractor Requisition FormSam Turner2021-09-23T13:43:47-06:00

Contractor Requisition Form

Please see the corresponding SOP for details

SOP – Process for Faculty 1099 Contract: https://bcomnm.org/FAF007/

Requestor Information:
Name:
First Last
Title:
Department:
Line Item Number from which compensation will be paid from:*
Visiting Faculty or Guest Lecturer Information:
Name:
First Last
Title:
Start Date:
MM slash DD slash YYYY
End Date:
MM slash DD slash YYYY
Proposed Compensation Rate:
Choose one and enter estimated amount
- Hourly @$150/hr (standard rate)
- Salary $______ (for a longer-term contract)
- One-time payment $ _______ (for an honorarium, one-time fee, etc.)
Amount:
Frequency of Compensation:
- One Time
- Reoccurring
Estimated hours:
Choose one & enter estimate hours
- Hours Total
- Hours Per Week
- Hours Per Month
Estimated Hours Amount:
Is this Contractor for the Clinical Medicine Department?*
- Yes
- No
Do we already have a faculty member at Burrell that can teach this content?*
- Yes
- No
Is there space in the budget for this contractor?*
- Yes
- No
Items to be attached: CV/Resume*
Drop files here or

Accepted file types: pdf, doc, docx, gif, png, jpg, Max. file size: 20 MB.
Items to be attached: Transcripts - if requesting a faculty appointment for a non-physician.
Drop files here or

Accepted file types: pdf, doc, docx, gif, png, jpg, Max. file size: 20 MB.
Enter a short description of work requested of visiting faculty/guest lecturer:*
(i.e. sessions to be taught, special directions for contract, etc.)
Hidden
Justification for Contractor:*
(i.e. Do we have someone at Burrell that can teach this session?)
Request Faculty Appointment:
- Check if requesting faculty appointment for guest lecturer
Elevated IT Access:
- No extra resources needed
- Yes – IT resources requested
Please select IT Resources needed:
- LEO/Panapto
- Zoom
- Burrell Email
- Library Access
- Lecture Hall Drive
- Building Key Card
- Equipment (to include computer, monitors, keyboard, etc.
- Other
Additional Information (optional):
Additional Files (optional):
Drop files here or

Accepted file types: jpg, pdf, png, doc, docx, gif, Max. file size: 20 MB.

For Questions:

Contact Director of Employment, cvaudrey@burrell.edu

CONTACT OUR OFFICE

Burrell College of Osteopathic Medicine
3501 Arrowhead Dr
Las Cruces, NM 88001

Phone: 575.674–BCOM (2266)
Fax: 575.674.2267

Admissions: admissions@burrell.edu
Financial Aid: financialaid@burrell.edu
Human Resources: hr@burrell.edu
Help Desk

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The Burrell College is a private, investor owned, medical school affiliated with New Mexico State University. The Burrell College is free-standing, separately licensed and independently operated entity and not part of New Mexico State University

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Contractor Requisition Form

Contractor Requisition Form

Requestor Information:

Visiting Faculty or Guest Lecturer Information: