Statement of Supplementary Professional Activities

STATEMENT OF SUPPLEMENTARY PROFESSIONAL ACTIVITIES

Includes all SPA while on sabbatical or assisted leave.

Write “NIL” if nothing to report.

Otherwise, your statement should include service performed while self-employed or for an outside employer (excluding contracts involving the University and University administered research grants) including teaching at other institutions.

Include the following details.

  the nature of the activity (i.e. services performed). Use the following headings;consulting, (contracted research),private practice,supplementary teaching(intersession, evening programs, extension - either through the University Faculty of Extension and/or provincial departments), andother activitiesif remuneration is received. Other activities could include provincial and federal committees, activities in professional organizations including international organizations, newspaper and media articles, and community activities.

  the category or type of client or affiliation.

  the primary location where supplementary activities are carried out (if off-campus give appropriate address).

  an estimate of the total time devoted to supplementary professional activities in the year being reported. This time is to be based on all activities regardless of whether conducted during regular university hours or at other times.

  a listing of all U of A facilities used for the SPA.

  a forecast of the supplementary professional activities to be undertaken during the current academic year (or the year following the year being reported). This can be done by including these items and marking with an asterisk.

By signing this report, the staff member is declaring that if the SPA involved the use of human subjects, the proposal was submitted to the Research Ethics Board and was in full compliance with human ethics standards.

Please refer to Article 8 of the Faculty Agreement and the supplementary statement of the Faculty of Agricultural, Life & Environmental Sciences.

Name:

Reporting Period: January 1, 2015 to December 31, 2015

Signature: ______Date:______