REQUEST FOR STIPEND
Stipend Type:
Copy to Payroll: ____________________________________
Is this a current SLOCCD employee?
If yes, department name: ________________________________
Position Title: ____________________________
Yes No
_______________________________________is authorized and agrees to perform the attached dates/services by
stipend at $_____________per hour, not to exceed ________________________/ or flat rate of $______________
(Work hours must be submitted via timesheet)
Account(s) #
____________________________________________________________________________________________
Description of duties: ____________________________________________________________________________
Services will begin on ____________________________ and terminate on or before ________________________
Department Contact: ______________________________________________ Phone Ext.: ____________________
Approvals:
Management Supervisor’s Signature:_______________________________________ Date:___________________
Vice President Signature:_________________________________________________ Date:__________________
President/Designee Signature: ___________________________________________ Date:__________________
Vice President Human Resources: __________________________________________ Date:__________________
Acceptance of Employment:
I acknowledge this is a temporary appointment and assigned workdays/work hours may vary. Renewal of stipend
is at the sole discretion of the District. This assignment does not qualify for fringe benefit coverage, vacation,
holiday, or sick leave.
I hereby accept employment and the conditions herein.
Employee Signature:__________________________________ Date:______________ Banner ID #:______________
Instructional Project
Non-Instructional Project Coaching
Pre-approval of the required documents must be submitted to Human Resources prior to performance of duties.
Authorization: Attach project summary and/or description of services being provided.
(Dollars)
(Dollars)
Human Resources Use Only: F/P Clearance: ______________________ Position ID # _________________________
(Employee Name)
