Name: Effective Date: / /
Employee/Student ID #
( ) Support Staff ( ) Administrator ( ) Faculty
q Already entered into People Soft
Hourly Rate
q Acting Pay - Start ____________
q Acting Pay - Ending ____N/A____
q Equity Adjustment ____________
q Merit Increase ____________
Lump Sum
q Bonus (Separate Check) ____________
* Note: Support Staff are not eligible for Stipends
For Support Staff and Administrators
Account #: Fund#: Dept.#: Program #: Project/Grant #:
5 digits 5 digits 5 digits 2 digits 7 digits
* No agency accounts may be used here (9xxxx Series Funds)
Name of (GL) #:
Department:
( ) Gettysburg College Student * Prior approval from Human Resources required for student stipend
Stipend
Lump Sum
Amount ___________ q Bonus (Separate Check) ____________
Start ___________
End ___________
Amount per pay ___________
Account #: Fund#: Dept.#: Program #: Project/Grant #:
5 digits 5 digits 5 digits 2 digits 7 digits
Signatures:
Originator____________________ / / Budget Office___________________ / / _
Supervisor____________________ / /
HR/PAYROLL USE ONLY
Co-Director / / _ Co-Director / / _ Payroll / / _ Benefits Specialist / / _ Office Assistant / /
Miscellaneous Pay Request Form
q Already entered into People Soft
Annual Salary
q Equity Adjustment ____________
q Merit Increase ____________
Bi-Weekly Rate
q Acting Pay - Start ____________
q Acting Pay - Ending ____N/A____
Lump Sum
q Bonus (Separate Check) ____________
q Stipend* ____________
[Start _______End _______]
Amount per pay ____________
* Beginning pay period
Office of Human Resources
& Risk Management
