Request for Employee Award
Version 8-19
Department Requesting Award Payment: ___________________________________________
Department Contact Name and Phone Number: ______________________________________
Employee Receiving Award: _______________________________ E#__________________
Recipient Job Classification: __________________________
Name of Award: ______________________________________________________________
Month of Payment: _________________________
Note – Form must be received in the Payroll Office by the 10
th
of the month for payment at month end.
Payment to be made from Foundation Index(s): F__________ Amount $__________
Note – May use up to 3 Foundation funding sources F__________ Amount $__________
F__________ Amount $__________
Total Amount of Payment $__________
If payment is made from Foundation Unrestricted Index (F-1XXXXX) - Benefits will be funded
centrally but will be recorded on Employees Primary Departmental Index.
Employee’s Primary Departmental Index: E________________
If payment is made from Foundation Restricted Index (F-2XXXXX) – Benefits will be funded by
the Foundation Restricted Index. I acknowledge funding benefits from Foundation.
APPROVALS:
______________________________________________
Funding Department Head Date
______________________________________________
Funding Dean/Director (if required) Date
______________________________________________
Funding Vice President Date
______________________________________________
ETSU Foundation Accounting Date
______________________________________________
Payroll Office Date
Form must be received in Payroll by the 10
th
of the month for payment at the end of the month.
Payroll Office
PO Box 70732
