[INSERT GSU DEAN’S OFFICE LETTERHEAD]

[INSERT DATE]

[INSERT STATE AGENCY CONTACT NAME & ADDRESS]

Dear[Mr./Ms./Title] [INSERT LAST NAME]:

I This letter serves to request permission forthatDr. [INSERT NAME], [INSERT TITLE], of the Department of [INSERT AGENCY NAME]receive permission to be a part-time instructor at Georgia State University. Dr.[INSERT NAME] is scheduled to perform these services commencing [INSERT START DATE], and terminating on [INSERT END DATE], unless earlier termination by the parties as provided below. [INSERT NAME] will be teaching [INSERT COURSE TITLE/NUMBER] in the Department of [INSERT DEPARTMENT NAME]. Such course is scheduled for [INSERT CLASS DAYS] from [INSERT CLASS TIMES] during this period.

Dr.[INSERT NAME] will receive a total of $[INSERT AMOUNT] as compensation for his/her services. Georgia State University will pay Dr. [INSERT NAME] directly for the services provided to Georgia State University. This request is in accordance with the provisions of O.C.G.A. 45-10-20, et seq. Dr. [INSERT NAME]has agreed to provide the above services for the above stated amount.

I have been informed by Dean [INSERT NAME] of the [INSERT NAME OF REQUESTING COLLEGE, i.e. College of Arts & Science’s]Dean that Dr. [INSERT NAME] is uniquely qualified for this task. I have also been assured that the interests of Georgia State University are better served by contracting for his services rather than seeking the service of persons less qualified who are not employed by the State.

This agreement may be canceled by either party by giving thirty (30) days written notice to the other party.

If this agreement will not have a detrimental effect on the association of Dr. [INSERT NAME] with the Department of [INSERT AGENCY NAME] and if you deem this arrangement to be in the best interest of the Department of [INSERT AGENCY NAME], please sign both copies of this letter in the space provided below and return one of the originals to us for our file. You may retain a copy for your files. This arrangement may be cancelled by either party by giving prior written notice to the other party.

Thank you for your assistance and cooperation in this matter.

Sincerely,

Mark P. Becker[INSERT NAME]

President, GSUDean, [INSERT COLLEGE NAME], GSU

Approved and accepted by:

Department of [INSERT AGENCY NAME]

______

Name:______

Signature: ______

Title:______