Additional Payment Request Form
Please complete the fields below
Type of Request *
X-Pay
X-Ben
Employee ID Number of person receiving additional payment *
Name of Employee receiving additional payment *
Is the Employee a Graduate Assistant? *
Yes
No
Has the Dean of the School of Interdisciplinary & Graduate Studies Approved the request?
Please attach the approval
.
Position Control Number that will be used for the additional payment *
Please provide details about the additional duties the employee will be performing *
PCN Speedtype
Beginning date of additional payment *
Ending date of additional payment *
Enter periodic or monthly amount of the additional payment *
Enter goal (total) amount of the additional payment by the end of the assignment *
Name of person making this request *
E-Mail of person making this request *
Additional email recipient
Supporting Files
Please upload a
single PDF
file that contains all relevant documentation
Department Name*
Clear
X