1
Contact Information
Please fill in the contact information for the person submitting this form
Submitter Name
Submitter Email
2
Faculty Information
Department/Division
Requester Name
Requester Email
Optionally, add any email addresses here that will also receive a notification email when the request is approved or denied.
Separate multiple addresses with a semicolon.
Faculty Member Name
3
Request
Please select the purpose of this request
Counter an offer from a competitor organization (include offer letter with your request)
Equity adjustment
Faculty member’s accomplishments that merit the increase
Other
Reason for the Request
e.g., to counter an offer from a competitor organization. (Include offer letter with your request), equity adjustment, or the faculty member’s accomplishments that merit the increase:
Amount of Requested Salary Increase with justification for the amount, and whether the increase would be to base pay or in the form of a supplement:
Salary source that would fund the increase:
Comparative Salaries with Similarly Situated Faculty (i.e., other faculty at the same rank or in the same or similar discipline). Provide all salary components, e.g., base, supplements, and include years in rank of all comparison faculty:
Name
Rank
Years
Base Salary
Supplement
Total
FTE
Comparative salaries for similarly situated faculty drawn from a national salary benchmark report. State what benchmark is used, what year salaries are reported for, and whether salaries reported are for 9-10 month or 12-month contracts:
Would the faculty member’s contract change (e.g., from a 10-month to a 12-month contract)?
Yes
No
If approved, when should the change be made effective?
4
Document Upload
Please upload any supporting documents
Submit