Office of University Research

Internal Clearance Form Cost-Sharing Addendum

Project Director:
Project Title:

Indicate the faculty/staff salary and fringe benefits committed as match to this project or research: (excludes salary/fringes charged directly to grant or contract) (fringe benefits will be paid by University centrally)

Name: Employee ID# Dept. ID#	WTU or % of full position	Total Project Salary: Fringe:	Period of Commitment: (mm/dd/yy)	Position Pool ID#: Signature of:
Name: Employee ID# Dept. ID#	WTU, or %	Salary $ Fringe $	Begin: End:	Position Pool ID#: Signature of
Name: Employee ID# Dept. ID#	WTU, or %	Salary $ Fringe $	Begin: End:	Position Pool ID#: Signature of
Name: Employee ID# Dept. ID#	WTU, or %	Salary $ Fringe $	Begin: End:	Position Pool ID#: Signature of
Name: Employee ID# Dept. ID#	WTU, or %	Salary $ Fringe $	Begin: End:	Position Pool ID#: Signature of
Name: Employee ID# Dept. ID#	WTU, or %	Salary $ Fringe $	Begin: End:	Position Pool ID#: Signature of
Transfer total to line 9.f. of Internal Clearance Form