Faculty Stipend and
Invoice Form
This form is for current WVMCCD Faculty (Full or Part Time) for college-related activities beyond their normal teaching or non-
teaching assignments.
Stipends are not to be used to perform work within the scope of the faculty member’s regular assignment or position.
Stipends are not to be used for teaching or curriculum development, except for grant-funded programs.
This agreement is not valid, and work is not to begin, until signed by all parties and returned to initiating department.
Hours worked must be reported on stipend invoice form in order to be paid. Hours must be reported. Stipends can no longer be
paid by a flat rate.
Department Initiating Stipend:
Date:
Name:
SS#: XXX-XX-
Current Position:
Full Time
Part Time
Mission
West Valley
1.
In detail, describe the specific assignment/project to be performed, expected time involvement, and the knowledge you possess to perform it.
If appropriate,
distinguish the stipend assignment from your current assignment. You may attach a separate sheet.
2. If this is for teaching or curriculum work, provide the name of the grant-funded program.
Start Date:
End Date:
Financial Analyst Initials
Schedule C Hourly Rate:
(Check with Faculty Specialist for rate)
OR
If employee is to be paid a different hourly rate, indicate rate:
Indicate below justification for paying a different rate:
Amount Not To Exceed:
Mandatory Payroll Deduction = +13.603%:
Total:
Pay by hourly invoice monthly:
Pay by hourly invoice at completion of
service: Return copy of processed stipend to:
# of Hours authorized for this stipend:
Employee
Print Name:
Signature:
Requestor
Print Name:
Signature:
Administrator
Print Name:
Signature:
Pres/VP/Vice Chanc*
Print Name:
Signature:
Personnel Specialist
Print Name: L.Kinley/N.Parker-Cornejo
Signature:
*Only administrators or managers may authorize the expenditure of funds and approve hours worked when invoices are submitted.
HUMAN RESOURCES USE ONLY
HR Specialist:
TB Exp:
STRS Creditable?
Yes
No
Approved for employment by Associate Vice Chancellor or Designee
Date
Stipend #
HR/bb/4/22/14 revised
Account #s
Date:
Date:
Date:
Date:
Date:
$ 0.00
$ 0.00
$ 0.00
$ 0.00
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
West Valley – Mission Community College District
HUMAN RESOURCES
STIPEND INVOICE
TO: West Valley-Mission CCD
Stipend Contract #
14000 Fruitvale Avenue
Saratoga, CA 95070
FROM:
NAME
SOCIAL SECURITY NO. XXX-XX-
ADDRESS
CITY STATE ZIP
DATE
Total stipend agreement:
$
Account Numbers
List the specific dates and total number of hours used to complete the assignment / project.
DATE HOURS DATE HOURS
Faculty Performing Service
/
Date
Print Signature
Approval of Requestor
/
Date
Print Signature
Budget Administrator / Dean
/
Date
Print Signature
Pres. / Vice Pres. / Vice Chanc.*
/
Date
Print Signature
*Only administrators / managers may authorize the expenditure of funds and approve hours worked when timesheets are submitted.
SEND STIPEND INVOICES TO PAYROLL
HR/bb/4/22/14 revised
# of Hours authoriz
ed for this stipend:
Total Hours worked for this invoice:
$ 0.00
0
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit