Office of Human Resources
Employment
Post Office Box 751
Portland, Oregon 97207-0751
503-725-4926 tel
503-725-5896 fax
1600 SW 4th Avenue, Suite 518
Portland, Oregon 97201
askhrc@pdx.edu
www.pdx.edu/hr
Cancellation of Appointment for Adjunct Pay
Prepared by
Department Name
Phone Number
Adjunct Employee Information
PSU ID Number
Position Number
Last Name
First Name
Middle Name
D
Instructions to cancel Adjunct Pay
Please Note: Excerpt from the University’s approved adjunct templates, “The University reserves the right to cancel one
or all of the courses listed, should enrollment, in the judgment of the University, be insufficient. If a cancellation occurs,
the University will pay a prorated amount for the number of classes held before cancellation and will pay for one class
meeting if the cancellation occurs before the first class meeting”.
Please attach a copy of the cancelled AFT/Adjunct letter of offer.
Partial Cancellation of Appointment
Number of credits employee is teaching is reduced.
(Ex: 4 of 8 credits were cancelled)
Full Cancellation of Appointment
Entire contract being cancelled.
(Ex: 8 of 8 credits were cancelled)
Course was cancelled after first class meeting. Pro-rata Payment for number of classes
held before cancellation:
$
Course was cancelled prior to first class meeting. Payment for one course meeting equals:
$
Term
Course Title
Revised total
credit hours
Revised
Payment
$
$
$
$
$
Total Payment
$
Additional Comments (i.e. instructor withdrew)
Signatures
Department Chair Approval
Date
Dean‘s Office Approval
Date
Updated 5/7/2010 - Employment