Independent Contractor Form

Blank Form (#63)

Independent Contractor Invoice

First Name

Last Name

Role

Didactic (Adjunct Faculty)

Clinical (Clinic Supervisors)

Current rate per hour

For the period 8/1 - 8/ only - please only include Summer semester hours, not Fall semester hours (yet)

Classes List (1)

Classes List (2)

Classes List (3)

Classes List (4)

How many hours did you teach this course?

If you need to submit both Didactic and Clinical hours,
please use a separate form for each invoice.

Your Pay

Total Pay

Classes List (1)

How many hours did you Supervise?

If you need to submit both Didactic and Clinical hours,
please use a separate form for each invoice.

Your Pay

Total Pay

Signature

Sign to certify your hours

Date