SAMFORD UNIVERSITY
Human Resources Department
Pay Request Form for Student Employees
NOTE: Use this form to make a one-time payment to a student.
NAME _______________________________________ SU ID __________________________
REASON FOR PAYMENT ___________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
BANNER FOAPAL: This will be used unless student employee has uncommitted federal work study funds.
Index: _____________ Fund: _____________ Org: ______________ Acct: 612000 Prog: _____________
HOURLY RATE $_____________ LIST EXACT HOURS BELOW. (Attach additional pages as needed)
TIMES WORKED (Begin and end times)
Student Employee Signature: ___________________________ Total Hours Worked:
Federal law requires that an I-9 and tax forms be completed before a student employee may begin work
unless these documents are already on file in Human Resources.
Supervisor Approval:
Name: _____________________________________ Department: __________________________
Signature: _________________________________________ Date: _______________________
Send completed form to the Payroll Office approximately two weeks before
pay date to allow time for processing.
For Payroll Use Only:
Payroll forms ________ Payroll ID ____________
Position _____________ Processed by __________
Revised 3/10
