JACKSONVILLE UNIVERSITY
Date Requested:
Pay Date Requested:
GROSS AMOUNT:
HRS
HRS
SICK
HRS
OTHER
HRS
Attachments to be mailed with check Yes: No:
REQUESTED BY: Dr. Sherri Jackson , Office of Experiential Learning
SUPERVISOR APPROVED BY:
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Special Instructions:
DO NOT WRITE BELOW THIS LINE
Date received in Payroll:
Received by:
Date check processed:
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*ALL REQUESTED INFORMATION MUST BE COMPLETED, TO ENSURE PROPER AND TIMELY
PROCESSING. JACKSONVILLE UNIVERSITY IS AN EQUAL OPPORTUNITY EMPLOYER.
YES NO
LEAVE TYPE USED:
VACATION
PERSONAL
OTHER HOURS EXPLANANTION:
ACCOUNT NUMBER:
REASON FOR REQUEST:
Internship, Research Intensive, Independent Study or Service-Learning Independent Study Course ID Number:
Name of Student Supervised :
Email of Student Supervised:
10/19/2018
10/30/2018
100.00
EMPLOYEE NUMBER:
PAY TO NAME:
ADDRESS:
ARE BENEFITS TO BE CONDUCTED:
11-00-43110-61130
PAYROLL CHECK REQUEST
for Oversight of Internships,
Research Intensive Independent Studies
& Service-Learning Independent Studies
Traditional Semester 18FAZ
Submit to lkenned6@ju.edu (Office of Experiential Learning) by 10/26/2018
