Clatsop Community College
1651 Lexington Avenue, Astoria, OR 97103
Phone: 503-338-2439 Website:
http://www.clatsopcc.edu
2020-21 Federal Work‐Study
Payroll Authorization Form
Student should return this form to the Financial Aid Office immediately after supervisor signs. Student and supervisor
should both keep a copy for their records.
Student Certification
I agree to accept employment in the department named above for the wage stated. I understand that I will be
expected to perform my duties in a responsible manner and to comply with the requirements of the job and the
instructions on my supervisor. I further understand that my employment is contingent upon satisfactory job
performance and that I may be removed from my position and from the Federal Work‐Study Program if I do not meet
minimum standards. I will accurately record my work hours and will maintain a record of my earning in order not to
exceed my FWS limit.
Student Signature
Date
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
Supervisor Certification
I agree to hire the above named student for the wage stated and under the conditions described above. I will
supervise the work performed and I will be responsible for approving the Work‐Study employee time record for the
Payroll Office. I understand that participation in the program is contingent upon satisfactory compliance with the
policies of the Work‐Study program. I will monitor this student’s hours to ensure that they do not exceed their award
for the term.
Supervisor Signature
Date
-
Work Study Wages
On‐campus $12.00
Off‐campus $12.50
Tutor $14.50 off campus/$12.25 on campus
Acct:
Student Section
Last Name:
First Name:
CCC ID:
Address:
E‐mail:
Enrollment: F W Sp
Supervisor Section
Name of Dept./Organization:
Supervisor’s Name:
Supervisor’s Phone #:
Supervisor’s E‐mail:
