student prize/award & undergraduate stipend request financial aid processing only does item type...
TRANSCRIPT
FOR FINANCIAL AID PROCESSING ONLY
Does item type exist for this payment?
☐ Yes, use item type _____________________ ☐ No, create item type
Student Prize/Award & Undergraduate Stipend Request
REQUEST TYPE: ☐ New ☐ Revision
QUALIFYING QUESTIONS Answer the following to ensure correct routing and processing of this form. Please choose a request type. ☐ Prize/Award ☐ Undergraduate Stipend
Is the payment to a US Citizen or Permanent Resident?☐ Yes ☐ No
If no, gross up?☐ Yes ☐ No
For undergraduate stipend requests, answer the following questions. Is the student working set hours? ☐ Yes ☐ No
Is the student receiving an hourly or standard wage? ☐ Yes ☐ No
Is the student’s activity directed by a supervisor?☐ Yes ☐ No
PAYMENT INFORMATION Attach additional explanation sheet(s) describing the purpose of this request with this form.
Amount Per Payment ____________________
Number of Payments ____________________
First Payment Month ____________________
Last Payment Month ____________________
___________________________
___________________________
___________________________
Award Intended Term
Dept. Contact Name
Dept. Contact Phone
Name of Award
This award is funded by
PAYEE INFORMATION Full Name _____________________________________ Student Type __________________ EMPLID OR VUnetID __________________
AUTHORIZATIONBy signing below, I certify that I have reviewed and approved the above payment per Vanderbilt University policies.
Financial Unit Manager Name Signature Date
Return completed form to [email protected] orOffice of Student Financial Aid and Scholarships
2309 West End Avenue, Nashville, TN 37203
Business Unit Manager Name Signature Date
Values above $10,000 require additional approval from the Business Unit Manager.
Entity3 digits
Net Class Asset 2 digits
Financial Unit 5 digits
Account Program3 digits
Activity 3 digits
Amount
Total Amount
Total Taxes Withheld
Net Amount
ProjectUp to 10 digits
OrganizationUp to 10 digits
Expenditure Type Task Up to 10 digits
Amount
Total Amount
Total Taxes Withheld
Net Amount