FEDERAL WORK-STUDY REQUEST
FORM 1-61000-19 (9/19)
FEDERAL WORK-STUDY REQUEST FORM
Obtain signatures for exceptions (wage & summer hours) prior to submitting form to Student Payroll Office.
Please complete this form in entirety and return to Student Payroll Office.
Students cannot begin working without approval from Student Payroll Office.
Date of Request:_
________________________
Requesting Department:_____________________________________________
Requested Start Date:______________________________
Budget Account Number: 430-35001-2115-51501
_____________________________ ___________________ _________
Name of Employee Student ID Number Date of birth
Male_____ Female_____
________________________________________ ______________________ ________/
hour
Job Title
Title Code *Compensation
Employment Status:
New
Rehire
Hours:
24 hours weekly maximum during fall and spring semesters (unless pre-authorized by
Executive VP of Administration and Finance) W/C Code: 8869
__________________________________________________________
Authorized Department Signature (Director)
____________________________________ ___________________
Student Work Coordinator Date
Pay rate exception: $_________/hour
Summer hour exception: __________hours per week
EXECUTIVE VP FOR ADMINISTRATION AND FINANCE MUST AUTHORIZE ALL PAY RATE AND HOURLY EXCEPTIONS
Signature of EXEC VP____________________________________________________________
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