Metropolitan State University of Denver
Student Employment - Exception Form
Rev 01/01/2019
This form is for students who are not enrolled in classes and have been requested to work over 30 hours a week. For those students only a supervisor signature is
required, vice presidential signature is optional. For students enrolled in classes, both supervisor and vice presidential signature are required.
REQUESTS WILL EXPIRE AT THE END OF EACH SEMESTER
I. Type of Exception Request
Requesting over 30 hours a week Night time employment
II. Employee Information
Employee Name (Last, First)
Employee 900#
Enrolled at:
MSU Denver UCD CCD Other
Please fill out this section only when requesting over 30 hours a week while a student is taking classes
Amount of credit hours student is enrolled in:
Completion Rate:
Is the student employed anywhere else on or off campus?
Yes No
If yes, please indicate approximately how many hours a
week they are working at the other job:
III. Department Information
Department
Supervisor Name
Phone #
Building and Room Number
IV. Reason for Request
A. Reason
Internship Coverage Skill/ Expertise Specific Position Special Project
Other Employee not enrolled in classes (summer semester, semester after graduation, etc.)
B. Semester and Year
C. Description- Please provide a more detailed description of the reason for the exception (attach separate paper if
needed)
V. Exception Specifics
1. Requesting Hours per week 2. How often will the employee be working while unattended by a supervisor? Hours
VI. Signatures (Appropriate signatures must be obtained for this form to be complete/ Off-Campus supervisors please contact the
Office of Human Resources for instructions regarding this form)
Supervisor:
Date:
Chair/Director:
Date:
Vice President of Academic Affairs:
Date: