KANSAS EMERGENCY MANAGEMENT & HOMELAND SECURITY TRAINING PROGRAM

(DEPARTMENTPROGRAM NAME) UNIVERSITY OF ARKANSAS STRATEGIES FOR IMPROVEMENTMAINTENANCE RESULTING
112008 SS5071 PAGE 1 OF 1 ARKANSAS STATE HIGHWAY
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1221 W 103RD STREET 303 KANSAS CITY MO 64114
137 STATE OF ARKANSAS PROCUREMENT LAW AND RULES SEPTEMBER

INSTRUCTOR PAYMENT REQUEST

Kansas Emergency Management & Homeland Security Training Program

INSTRUCTOR PAYMENT REQUEST

Instructor Information

Instructor Name:


Home Mailing Address:




Social Security Number


Telephone


Type of Payment Requested:


Honorarium

Itemized hotel receipt must be attached.


Lodging


Dates of Course: From:


To:


Total Classroom Hours:


Name of Course:


Course Location:






Instructor Signature

Date

Payment can NOT be made for forms submitted more than 30 days after the ending date of the course.

Honorarium’s are paid at the rate of $25 per hour of course delivery and will be established by the Training Program Manager prior to the beginning of each course. Honorariums and lodging expenses will be paid to the instructor and not to any organization or agency. Instructors are responsible for any tax implications associated with providing the service for a fee.


Training Program Manager Approval


Approved

Honorarium Total $


Rejected

Lodging Total $

Comments:

Total Payment: $




Training Program Manager Signature

Date


Revised June 2010




Kansas Emergency Management

2800 SW Topeka Blvd

Topeka, Kansas 66611-1287

T: 785-274-1412 F: 785-274-1914



1B EWARE OF BROKEN GLASS ARKANSAS WORKERS’ COMPENSATION COMMISSION
1UNITED STATES DISTRICT COURT DISTRICT OF KANSAS UNITED STATES
2021 KANSAS BIG YEAR RECORDING RULES PARTICIPANTS WHO SUBMIT


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