Summer & After School Learning Hours

Summer & After School Student Learning - Stipend Pay Request

Review guidelines below before proceeding.
IMPORTANT: Hours submitted on this form should only include instructional time outside of the regular school day. Pay for the hours submitted will be at the staff member's calculated daily/hourly rate.

Hourly employees may not work or submit hours if the total of all hours for the week exceed 40.
Name*

First NameLast Name
Last 4 digits of Social Security #*
Last 4 digits only
Email Address*
Location of Instruction*
If submitted hours are for different location, select the location where which represents the most hours
Your "Normal" School Day Role*

10 days is the limit for this form. If you have more than 10 days to submit, complete this form for the first 10 days and submit an additional form for day 11 and so on.

Select "Next" to complete this form.

TOTAL # HOURS
AUTO-CALCULATED
The TOTAL # HOURS shown above is auto-calculated. If it is not correct, use the Back button to review and correct your entries.

A copy of your submission will be sent to your email address for your records.
The submitter attests to the accuracy of all information entered on this form. If so, please SIGN & SUBMIT*

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Summer & After School Student Learning - Stipend Pay Request