HOST FAMILY PAYMENT AGREEMENT
THE CSU,CHICO RESEARCH FOUNDATION
RESEARCH AND SPONSORED PROGRAMS
This form constitutes an agreement to provide meals and lodging for
, a participant in a Research Foundation funded project.
Host Name:
SSN: (last 4 numbers)
Address:
Dates of Service:
Compensation:
(food) and
(lodging)
I understand that in providing said meals and lodging I am not acting as an employee or agent of The
CSU, Chico Research Foundation, that I am solely liable and responsible for all Federal and State taxes,
that I am not covered by Workers' Compensation or Unemployment Insurance or eligible for any fringe
benefits, and that I agree to hold The CSU, Chico Research Foundation and California State University,
Chico harmless to indemnify and/or defend the University Foundation in any legal proceedings that arise
out of the performance of this contract by any party.
Signature
I certify that the above services have been completed, that the compensation hereby approved for
payment is appropriate to the service performed, that the services were necessary and could not be
performed by anyone currently employed by the project, and that a selection process was used to assure
the qualifications of the family to perform the services.
Date:
Signature of Project Director
Signature of Research Foundation Analyst
_
________________
RF Project Number
Rev: 01/07
Date