FACULTY NAME IRN UNIVERSITY OF PHOENIX FACULTY EMAIL WHAT

Faculty Name:

IRN:

University of Phoenix Faculty email:

What Phone Number can we contact you at if there are any questions about your submission?

What is your Primary College?

Are you a full-time staff member with the University of Phoenix?

Please tell us about your submission for honorarium. Please remember that Honorarium can be presentations at regional, national, or international professional or academic conferences or published scholarship in a professional or scholarly venue. Submissions for honorarium consideration must have visibly demonstrated the faculty’s affiliation with University of Phoenix within their presentation, the program, or in their publication.

What is the title of the presentation or publication?

When did this activity occur? (Month/Day/Year)

What is the associated professional association or sponsor/host organization of this activity?

Please provide the URL (direct web link) to the to the conference/publication (if available, if no URL is available, please include a copy of the publication in your submission):

In order to be considered for Honorarium you must have recorded this activity in your Faculty Credentials. Please type your initials in the box to the right to acknowledge you have recorded this activity.

Please ensure to email this completed form along with supporting documentation* to [email protected]

*Examples of supporting documentation may include conference presentation, conference agenda, brochure, link to the conference website, physical publication, copies of the publication, link for online publication, ISBN, etc. Word documents or PowerPoint presentations cannot be the only documentation submitted; official documentation must be provided as well.