Fillable Instructions for Completing State Work Study Time Sheet (Washington)

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Instructions for Completing State Work Study Time Sheet (Washington)

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Instructions for Completing State Work Study Time Sheet
Student: Complete the Student Section. For the “First day hours were worked” enter the first day (month/day/year)
in this pay period on which you worked. For “Last day hours were worked” enter the last day (month/day/year)
in this pay period on which you worked. Enter the number of hours you worked under “Record of hours worked”
next to the appropriate date. At the end of the pay period, total the “Record of hours worked” and enter that
figure on the “Total hours worked” line. Read and sign the statement regarding your certification of the hours
reported and your continued eligibility for the State Work Study program. Be sure to date the form on or after
the last day worked. Give the form to your supervisor.
Employer: After paying the student for the hours reported in the Student Section, complete all of the
information requested in the Employer Section. Line 13 (FICA) is only for Social Security and Medicare
deductions. Line 14 (Other deductions) is for all other deductions including, but not limited to, federal
withholding tax, Worker’s Compensation, and health insurance. Read the employer’s certification statement,
then sign and print your name, and date the form (on or after the last day the student worked). Retain a copy of
the time sheet for your records. Forward the original to the student’s college for processing. Important:
Complete the time sheet accurately; any blank or incorrect items may delay your reimbursement. Time sheets not
forwarded to the student’s college within 15 days of the end of the pay period may deny reimbursement.
College: Verify the information on the time sheet. Once verified, complete the College Section, including
institution code (from the list below). Retain a copy of the time sheet for institutional records. Forward the
original to the Washington Student Achievement Council (WSAC) for employer reimbursement. Incomplete or
late time sheets submitted to WSAC can result in delayed or denied reimbursement for employers.
INSTITUTION CODES (WSAC assigned)
3080
Antioch University
3130
Northwest University
3190
University of Puget Sound
3090
Bastyr University
3140
Pacific Lutheran University
3200
Walla Walla University
3100
Cornish College of the Arts
3150
Saint Martin’s University
3210
Whitman College
3110
Heritage University
3160
Seattle Pacific University
3220
Whitworth University
3120
Gonzaga University
3170
Seattle University
EXAMPLE
1. Student Section:
Student fills out entire
left side of the time
sheet.
2. Employer Section:
Employer completes top ¾
of right side of the time
sheet. In order to receive
prompt reimbursement,
ensure the time sheet is
completed accurately and
submitted to the college
within the 15 days of the end
of the pay period.
In order to expedite the
employer’s reimbursement,
submit the time sheet to
WSAC within five days of
receipt.
WASHINGTON STATE WORK STUDY PROGRAM
TIME SHEET
Washington Student Achievement Council 6/2017
STUDENT SECTION
1.
Last Name, First Name
2. ___ ___ ___ – ___ ___ – ___ ___ ___ ___
Social Security Number
3.
Name of College
4.
Job Title
5. First day hours were worked:
Month/Day/Year
6. Last day hours were worked:
Month/Day/Year
7. Record of hours worked:
01 __ __ . __ __ 16 __ __ . __ __
02 __ __ . __ __ 17 __ __ . __ __
03 __ __ . __ __ 18 __ __ . __ __
04 __ __ . __ __ 19 __ __ . __ __
05 __ __ . __ __ 20 __ __ . __ __
06 __ __ . __ __ 21 __ __ . __ __
07 __ __ . __ __ 22 __ __ . __ __
08 __ __ . __ __ 23 __ __ . __ __
09 __ __ . __ __ 24 __ __ . __ __
10 __ __ . __ __ 25 __ __ . __ __
11 __ __ . __ __ 26 __ __ . __ __
12 __ __ . __ __ 27 __ __ . __ __
13 __ __ . __ __ 28 __ __ . __ __
14 __ __ . __ __ 29 __ __ . __ __
15 __ __ . __ __ 30 __ __ . __ __
31 __ __ . __ __
8. Total hours worked:
“I hereby certify this time sheet is a true and correct
statement of the hours I worked, and that I have State
Work Study eligibility to cover my gross earnings.”
9. _________________________________________
Student’s Signature
10.
Date Signed (on or after last day worked)
EMPLOYER SECTION
Verify the information in the Student Section. Complete
all items requested in this section. Any incorrect or blank
items may delay reimbursement.
Submit the time sheet to the student’s college within 15
days from the end of the current pay period to prevent
delay or denial of reimbursement.
11. Hourly rate of pay: $
12. Gross compensation: $
13. FICA: $
(Social Security & Medicare)
14. Other deductions: $
15. Net earnings: $
16. _____________________________________
Name of Business or Organization
17.
Employer Identification Number (EIN) Suffix
“This time sheet is a true and correct statement of
the time worked by this student. The student has
completed the assignment satisfactorily, continues
to have State Work Study eligibility, and has been
paid by check or direct deposit the amount of net
earnings as shown. I hereby certify, under penalty
of perjury under the laws of the state of
Washington, the foregoing is true and correct.”
18.
Supervisor’s Signature
Supervisor’s Name
19.
Date Signed (on or after student’s last day worked)
COLLEGE SECTION
20. Date received by college:
21. Authorized by:
22. Institution code:
23. Position number:
24. Reimbursement rate:
25. Reimbursement amount: $
0.00
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Instructions for Completing State Work Study Time Sheet (Washington)

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Completed 29 June 2022

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