SOUTHERN WEST VIRGINIA COMMUNITY AND TECHNICAL COLLEGE
External Professional Activities for Pay Report Form
SCP-2562.A
Instructions: In accord with SCP-2562, this form must be completed each year by all full time faculty and professional staff
employees. Complete all parts of the form. If you did not engage in external professional activities for pay for the fiscal year
specified, write “NONE” across the grid below. Please report all paid activity/employment, including planned activity/
employment for the fiscal year. The report for each fiscal year is due in Human Resources by August 31. If you intend to
engage in paid professional activity, this form is to be completed no less than ten days before the proposed external
professional activity for pay is to begin.
Name
Title
Department/Unit Fiscal Year
Employee Signature and Printed Name Date
I have reviewed the above activities for compliance with SCP-2562, External Professional Activities of Faculty and Other
Professional Staff.
Supervisor Signature Date
SCP-2562.A, External Professional Activities for Pay Report Form Page 1 of 1
Start Date End Date Description of Activity
Explanation: Nature of Activity and General Description of Business/Agency/Organization/Groups/Person
Explanation: Nature of Activity and General Description of Business/Agency/Organization/Groups/Person
Start Date End Date Description of Activity
Explanation: Nature of Activity and General Description of Business/Agency/Organization/Groups/Person
Start Date End Date Description of Activity
Explanation: Nature of Activity and General Description of Business/Agency/Organization/Groups/Person
Start Date End Date Description of Activity
