July 2002UW-MADISON
ACADEMIC PERSONNEL OFFICE
REQUEST FOR RATE CHANGE
FOR FACULTY
DATE: ______SS #: ______
EMPLOYEE'S NAME: ______APPT #:______
DIVISION/DEPARTMENT: ______UDDS:______
______UDDS:______
CURRENT
TITLE: ______/ ______CURRENT SALARY: ______PER ______
(title code) (as of proposed effective date) (basis)
PROPOSED EFFECTIVE DATE: ______PROPOSED BASE ADJUSTMENT: $______(_____ % increase)
TEMPORARY ADJUSTMENT: Yes ____ No _____
PROPOSED SALARY: *______PER ______
If yes, End Date (if known) ______(excludes the July 1 compensation plan increase; (basis)
follow budget instructions regarding required merit)
Major department must obtain signatures of other funding/budgetary
departments (except for Summer Session and Research Committee funds).
The signatures of the following individuals indicate that approval is granted for a base adjustment and/or title change.
SIGNATURE(S) OF SUPERVISOR: ______
(date)
______
(date)
SIGNATURE(S) OF DEPARTMENT ______
CHAIR/DIRECTOR:(date)
______
(date)
SIGNATURE(S) OF DEAN/DIRECTOR ______
OR DESIGNEE:(date)
______
(date)
APPROVED: ______
(Academic Personnel Office) (date)
CHECK APPROPRIATE CATEGORY:
1.Change in Duties. Complete reverse side.
2.Administrative Assignment. Complete reverse side.
3.Equity Adjustment. Complete the information above and attach summary (see UPPP Ch. 10.01 C.).
4.Market/Competitive Factors--Outside Offer. Complete the information above and attach summary (see UPPP Ch. 10.01 D.1.).
5.Market/Competitive Factors--Retention. Complete the information above and attach summary (see UPPP Ch. 10.01 D.2.).
6.Market/Competitive Factors--Competitive. Complete the information above and attach summary (see UPPP Ch. 10.01 D.3.).
7.Error. Complete the information above and attach a memo stating the reason/s for the request.
FOR APO USE ONLY
IADS Code: ______
*Requested salary must be within range for NOTE:Base adjustment requests for other
proposed title. Exceptions for aboveunclassified staff, e.g., employees-
maximum require prior approval fromin-training, etc., may be in the form
UW System.of a letter to APO.
SECTION TO BE COMPLETED FOR CATEGORY 1 OR 2.
Describe changes in/additional responsibilities.
______
______
______
______
______
______
______
RETURN COMPLETED FORM TO:
Academic Personnel Office
174 Bascom Hall
s:\e\ohr\Emuye\Rate Title Chng--FA7/02