* Student Name:

* Student ID #:
DO NOT USE STUDENT SOCIAL SECURITY # FOR ID

Student HRMS Employee ID. #:

* Department Name:

* Contact Person:

* Email:

* Phone#: Fax #:
Campus Box:

Completion of this form does not guarantee that a transfer will occur. You will be notified in writing whether or not a transfer is completed.

Fall 2012

* Pay Period End Date:(Check all that apply)
09/01/2012 -- WSR Amount: WSC Amount:
09/15/2012 -- WSR Amount: WSC Amount:
09/29/2012 -- WSR Amount: WSC Amount:
10/13/2012 -- WSR Amount: WSC Amount:
10/27/2012 -- WSR Amount: WSC Amount:
11/10/2012 -- WSR Amount: WSC Amount:
11/24/2012 -- WSR Amount: WSC Amount:
12/08/2012 -- WSR Amount: WSC Amount:
12/22/2012 -- WSR Amount: WSC Amount:

* Charge to:
(Do not include speedtype). If submitting a suspense request to transfer funds, please enter the correct FOPPS that the earnings are to be transferred to.

Fund: Org:
Program/Project:

Spring 2013

* Pay Period End Date:(Check all that apply)
01/05/2013 -- WSR Amount: WSC Amount:
01/19/2013 -- WSR Amount: WSC Amount:
02/02/2013 -- WSR Amount: WSC Amount:
02/16/2013 -- WSR Amount: WSC Amount:
03/02/2013 -- WSR Amount: WSC Amount:
03/16/2013 -- WSR Amount: WSC Amount:
03/30/2013 -- WSR Amount: WSC Amount:
04/13/2013 -- WSR Amount: WSC Amount:
04/27/2013 -- WSR Amount: WSC Amount:
05/11/2013 -- WSR Amount: WSC Amount:

* Charge to:
(Do not include speedtype)
Fund: Org:
Program/Project:

*Reason for Transfer:

* You must submit the Suspense/Employer Charges to Work-study Transfer request to our office by 6/22/13 to charge in the 2012-2013 Fiscal Year. *You find WSR under 407700 which is 30% charge. WSC is found under 407600 which is 100% charge.