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

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