REQUEST TO CONDUCT PAID PROFESSIONAL SERVICE FOR MARYLAND STATE AGENCY 

UMCP Policies and Procedures on Conflict of Interest and Conflict of Commitment
(II-3.10A and II-3.10B) require that: 

	Paid consultancy or professional service to another State agency must
	be approved in advance by the Department Head and the President.
	A written explanation of the services to be rendered, the time involved,
	and the agency should be submitted. 

To obtain such approval, the following should be filled out, signed by the Unit Head, and
submitted for approval to the President’s designee. A signed copy of the approval will be
returned to the Unit Head. 

Faculty or Staff Member’s Name:

Unit:

MD Agency for which professional service is to be provided:

Date on which professional service will occur:

Nature of Service:

Estimate of total time involved:

Comments or special conditions: 


Approved by Unit Head: 
Date:

Approved by the President’s Representative*:
Date:

* For faculty this is the Provost and for staff it is the Director of Human Resources.