Report for through

1. Name:
2. Department or College:
3. Approximate percent of time spent on federal “lobbying activities” (including “lobbying contacts” and “efforts in support of such contacts”) during the specified period	%
4. Amount of your salary during the specified period: (if reporting any amount during specified period)	$
5. Line 3 x Line 4:	$
6. Actual out-of-pocket expenses incurred in connection with federal “lobbying activities” during the specified period:	$
7. Total expenditures in connection with federal “lobbying activities” during the specified period: (Line 5 + Line 6)	$

Lobbying Disclosure Form