ICSW FACULTY PAYMENT INVOICE Please use this form in order to receive payment for all work done at ICSW. Submit to Michael Bauman by the following dates: Fall Courses January 31, 2020 Spring Courses May 31, 2020 Summer Courses August 31, 2020 Practicums Billing Dates September 30, 2019 January 31, 2020 May 31, 2020 Dissertation Committees, and Other One-Off Billings 30th of Each Month Date of Submittal Name of Faculty Member Address Phone Number Social Security Number Courses Taught: Course Name
Clinical Practicum: Student
Course Code
Name of Practicum
Semester
Fall or Spring Start?
Invoice Amount
Invoice # (1, 2, or 3)
Invoice Amount
Other Billings: Student
Reason for Billing
Invoice Amount
Invoice Total: Total Amount Due Signature CV Submitted Grades Submitted
Y Y
N N
Malpractice Ins. Submitted Syllabus Submitted
Y N Y N