Payroll
Wells Hall Room 113
STUDENT WORK TERMINATION FORM
(To Be Completed By Supervisor, Student or Payroll)
Name:__________________________ Banner Id. 900____________________
Position Number: ______________ Department:_______________________
Termination Date:__________________
Reason for Termination:
____Withdrawal From School
____Graduation
____Academic Suspension
____Unsatisfactory Progress (per Financial Aid)
____Transfer to Another Job
____Enrolled Less than Full Time
____Other____________________________________
New Mexico Institute of Mining and Technology is an
Equal Opportunity/Affirmative Action Institution.
PD0001 Revised - 27 Mar 2018
Payroll Use Only:
Entered By:
Verified By:
Date
Date
Student Signature
DISTRIBUTION: ORIGINAL- Payroll Copies to - Financial Aid Office and Department
Supervisor Signature