UG_____ GR_____
Previously Employed on Campus Y_____ N_____
2020-2021 Federal Work-Study Authorization Form
Student Section:
Student Name: _________________________________________________________________________________________
Student ID: ____________________________________________ Date of Birth: __________________________________
Student Certification:
I agree to accept employment in the department named above. I understand that I will be expected to perform duties in a
responsible manner and to comply with the requirements of the job and the instructions of my supervisor. I further understand
that my employment is contingent upon satisfactory job performance and that I may be removed from my position under the
Federal Work Study Program if I do not meet minimum standards. I will supply my supervisor with a copy of my class schedule,
accurately record my work hours on a time sheet, and will maintain a record of my earnings in order not to exceed my limit. I
understand that I cannot start to work until I submit this authorization form to the Office of Financial Aid and Scholarship and I
receive confirmation from Human Resources that I am able to start working.
Student Signature Date
Supervisor Section:
Supervisor Name and Title: ________________________________________________________________________________
Name of Department: ____________________________________________________________________________________
Phone Number: _________________________________ Email Address: ________________________________________
Supervisor Certification
I agree to hire the above named student. I will supervise the work performed and I will be responsible for signing and forwarding
the Work-Study employee electronic or paper time record to the Payroll Office, retaining a copy for my records. I will also be
responsible for maintaining a record of student earnings and may not pay students beyond their earnings limit, which may be
changed from the amount above by the Office of Financial Aid and Scholarships. I understand that participation in the Program
is contingent upon satisfactory compliance with the policies and procedures outlined on the financial aid website. I further
understand that any violation of those procedures many jeopardize this department’s participation in the Program. I understand
that the student cannot start working until he/she submit this authorization form to the Office of Financial Aid & Scholarship and
I receive confirmation from Human Resources that he/she is able to start working.
Supervisor Signature Date
For Office Use Only: Employment Payroll Period July 1, 2020 to June 30, 2021
Hourly Wage: $______________ FWS Award: $_______________ Registered______
Authorized Maximum Hours of Employment per Week: ___________ HRD____________
OFAS Approval Signature__________________________________________ RRAAREQ__________
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