Guest Lecturer/Artist Honorarium Letter Department:

Honorarium Amount:Dept Contact: Dept Contact Phone:

2. Are you a U.S. citizen or permanent resident?

YES NO

4. The payment and/or associated expenses I will receivefrom CSULB are for usual activities and do not/will not lastmore than nine days

YES NO

If the answer to question 2 is "YES" please stop here.

Date(s) of Visit: Event/Lecture Series:Activity Performed:

To be completed by honorarium recipient:

1. Are you currently an employee in the CSU System?

3. In the previous 6 months, have you received paymentsand associated expenses from more than five institutions?

California State University, Long Beach Academic Services Bldg., Room 1151250 Bellflower BoulevardLong Beach, CA 90840-2004

YES NO YES NO

If the answer to question 2 is "NO" please answer the following questions:

Honorarium Recipient Signature: I acknowledge my understanding of this letter and agreement to the content herein.

_____________________________________________________________________ Name:

Date:

To:

We are honored that you have accepted our invitation to visit California State University, Long Beach. In appreciation of your contribution we would like to offer you an honorarium. If the information stated below is accurate and satisfactory to you, please sign below and return this letter to the department.

In order to process your honorarium, we respectfully ask that you submit a Vendor Data Record 204 Form. This form ensures that you are added into our recordkeeping system and must be on file before payment can be issued. If you did not receive a copy of this form, please contact the department contact listed below.

Please be aware that payment made to a foreign national is subject to U.S. federal withholding tax of 30%. Payment may be exempt from withholding only if there is a tax treaty benefit between the United States and the foreign national’s country, and a Social Security (SSN) or Individual Taxpayer Identification Number (ITIN) is needed in order to receive the tax treaty benefit.

Thank you in advance for your role in helping to educate our students!

Sincerely,

To be completed by the department staff: