REQUEST FORM
In-Range Progression Bonus Stipend
STEP 1: Please provide a written justification/rationale for the recommended in-range progression, bonus, or
stipend increase based on the criteria provided in the guidelines. Attach justification/rationale to this completed
form and submit the entire packet to Human Resources Management (HRM). If there has been a significant
change in responsibilities, please provide a revised position description.
STEP 2: Complete the following information.
Employee’s Name: _____________________________ Classification: ______________________
Department: __________________________________ Bargaining Unit: _____________
Amount/Percent Recommended: __________ Budget Funding Source: ______________________________
___________________________ ___________________________ ____________
Signature of Supervisor Title Date
STEP 3: Dean or Director: (Please complete this section and submit to the Vice President for further
recommendation)
Recommended
Not Recommended
_________
_________________ _______________________
Signature of Dean/Director Date
STEP 4: Vice President: (Please complete this section and submit to HRM for approval)
Recommended
Not Recommended
_________
______________ _______________________
Signature of Vice President Date
STEP 5: Human Resources Management:
Approved
Not Approved
_______________
_______
Da
te
_______________________________
Signature of Associate Vice President
Human Resources Management
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