SPA Service Provider Form

SPA Service Provider Request Form

Please complete this form to initiate the payment process for an individual or an organization who will be providing a service to the the School of Public Affairs (guest speaker, trainer, presenter, consultant, etc.). The information provided will determine the type of payment SPA will be required to process (Service fee, honorarium, consultant fee, etc.). Please do not use this form if the individual has an employee affiliation with the University of Colorado (any of the four campuses). Please contact the SPA HR Director to process payment to an individual with an employee affiliation with any CU campuses.

Does the Service Provider charge a fee?*

Yes No

How much is the Service Provider's fee?* $

Will we be paying an individual or an organization for the Service?

Individual Organization

If there is no required fee, we can offer an Honorarium pay (if budget allows). If you would like to pay an honorarium, please specify amount below. If this is a study subject pay, please specify amount below. $

Will this be charged to a Sponsored Project? (Please only select "Yes" if your speedtype starts with a 630 or 631)*

Yes No

Speedtype/Budget to pay from:*

Begin Date of Service

End Date of Service

Name of Service Provider

First Name

Last Name

Organization (if applicable)

Address

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Email*

Phone*

What is the business purpose?*

Other costs to be covered by SPA?

Requestor's Name (individual completing this form)*

First Name

Last Name

Requestor's Email Address*