DUAL EMPLOYMENT PERMISSION FORM

WESTERN CAROLINA UNIVERSITY
CULLOWHEE, NORTH CAROLINA

Date: _____________________________________________________________

Name:_____________________________________________________________

Outside Agency:____________________________________________________

Amount:___________________________________________________________

Reimbursement through the University? Yes______________ No_____________

Period Covered:_____________________________________________________

Approved:__________________________________________________________
(Dean/Director)

Approved:__________________________________________________________
(Provost)

This form is in addition and prior to the OSCPXA 03 form which must be filed for dual employment