AP FORM 107C / FACULTY/STAFF OTHER SUPPORT
TIME/FRACTION (OSF)
LABOR DISTRIBUTION /
Employee Name:
Empl ID: Dept ID: / / Department:
Reimburse Dept ID / Date:
Project/Program: USE AP107-B (Assigned Time) for University Campus Programs (UCP) Funded Activities
1Cal Poly Corporation Sponsored Programs Funding # Grant Proposal #
2Other Funding # (state or lottery)
Brief Description of Project:
Salary/benefits will be reimbursed by grant or project fund
Salary/benefits will be charged directly to other state or lottery fund identified above - complete Position Funding Form located at https://afd.calpoly.edu/business_connection/documents/Position_Funding_Form.docx
FACULTY EMPLOYEE: Other Support Time Information / Accounting Office use ONLY
Quarter AY
Fall
Winter
Spring
Summer / Year / Actual
WTU** / Release % Time
(based on 15 wtu’s)
%
%
%
% / Quarterly Salary Amount
charged to alternative source
(required for dept to receive credit)
$
$
$
$ / Benefit Amount
$
$
$
$ / Total Amount
Qtrly Sal Amt + Benefit Amt
$
$
$
$
12 Month
Start Date: / End Date: / Salary Amt
% of Time: $ / Benefit Amount / Sal Amt + Benefit Amt

STAFF EMPLOYEE: (information not entered in PeopleSoft) Salary Amount Benefit Amount Total Amount

% of time From: To: $ $ $
Check here if time is for documentation purposes only with no reimbursement.
APPROVALS
By signing below I certify that the above reflects my planned level of effort as indicated, and that an immediate notification will be made if a significant change in my work activity occurs.
Employee Signature (required):______Date: ______Project Director Approval (required for grants): ______Date: ______By signing below, I certify that the faculty employee has been released from an equivalent teaching assignment.Dept Head/Chair Approval (required):______Date: ______1For grants administered through Sponsored Programs send to CPC Sponsored Programs for approval:CPC/Sponsored Programs Funding Approval: ______Date: ______2For all other funding sources, send to the appropriate entity responsible for funding the release time for approval:Other Funding Source Approval: ______Date: ______By signing below I understand that should the above CPC Sponsored Programs other special fund not have sufficient funds to cover the OSF costs, this employee’s salary and benefits expenses will be charged to their regular state payroll unit account. By signing below I agree to release the faculty/staff member above for the time & amount indicated above.
Dean/VP/Manager Approval (required): ______Date: ______Provost Approval: ______Date: ______

Term Workload Panel Completed by College Analyst: ______Date: ______

** Do not include IRRs - WTUs are not to be altered when entering data into the Term Workload Panel

• College Analyst: If data is entered after the Preliminary FAD review period is complete, send a copy of the fully executed form to Institutional Research
Original (fully executed): Fiscal Services Copy: PAF in College Dean’s Office (each office is expected to make and distribute required copies)

AP 107C (Rev 07/17) (https://academic-personnel.calpoly.edu/content/forms)