* Is this for the summer or the academic year?
Please fill in the year that you are requesting for.
* Academic Year (i.e. 2013-2014) or Summer (i.e. Summer 2013):
* Student Name:
Student Mailing Address:
* Student ID #:
DO NOT USE STUDENT SOCIAL SECURITY # FOR ID
Student HRMS Employee ID #:
* Student Phone #:
* Student CU E-mail Address:
* Employer Name (Dept/Agency):
* Employer Address/Campus box:
* Employer Phone #:
Employer Fax #:
* Supervisor Name:
* Supervisor E-mail:
Please provide the following information so that we can process your request:
Is this student currently working for your department?
If yes, what was the student's start date? (MM/DD/YY)
Do you have hourly earnings to transfer for the student? Yes No
If the student's only financial aid eligibility consists of accepted loans, he/she is willing to decline loans in the following amount:
(Note: Loan funds that have already disbursed must be repaid to the Bursar's Office)