FIN - Request for Check/Payment to student

Please use this form for requesting payments or reimbursements to a student. If you have many of the same ?(>10)?, please contact Financial Aid about the option to submit a spreadsheet list.

Date Date / MM / DD YYYY
Payment to:
Colleague ID (OneCard) of payee
Must be 7 characters. Currently Entered: 0 characters.
Please use leading zeros if fewer than 7 digits.
Payee Email Address:
Recipient Primary Status:

Recipient Primary Status: Student
Has the student ever had a job on campus?

Has the student ever had a job on campus? Yes No

You will be redirected to the Student Hiring Form on submission of this form if the student has not previously worked on campus.
Type of Payment

Type of Payment Payment for Service/Work performed Reimbursement Prize/Award Other Other
Reimbursement for:

Reimbursement for: Food Mileage Purchase of Supplies Registration Travel - other than mileage Other Other
Detailed Description Of What The Funds Are In Regards To:
(this description will be included in an email to the student notifiying them of the payment)
Total Amount Requested: $ Dollars . Cents
Charge to Budget Account Number:
Must be 16 characters. Currently Entered: 0 characters.
Use the following format: xx-xxxxxxx-xxxxx

If your are requesting advance funds, use Account #10-0000000-13484
% to this Budget Acct No.
Must be a number less than or equal to 100.
Email - Person with Budget Authority (if different than submitter)
Charge to Budget Account Number:
Must be 16 characters. Currently Entered: 0 characters.
Use the following format: xx-xxxxxxx-xxxxx

If your are requesting advance funds, use Account #10-0000000-13484
% to this Budget Acct No.
Must be a number less than or equal to 99.
Email - Person with Budget Authority (if different than submitter)
Date When Needed: Date When Needed: / MM / DD YYYY

Funds will generally be paid as soon as practical, if a later date is needed you may indicate here.
Were any Advanced Funds received?

Were any Advanced Funds received? Yes No
Amount of Advanced Funds received
Please be advised that we are a tax exempt entity, and should not be paying tax on purchases. Refer to the procurement guidelines if you have any questions.

(All Technology Purchases should be made by the IT Department)
Upload Supporting Documentation for Reimbursement (receipts, etc.)
Upload Documents that support or qualify the request for payment.
Email - Person Requisitioning/Submitter
By signing electronically below, I confirm that I am able to access information in an electronic form and I also agree that the institution does not need to provide me with an additional paper (non-electronic) copy of the document unless specifically requested.

Draw or Type

Signature of Person Requisitioning Clear

Full Name

Signature of Person Requisitioning
Spam Protection. Please answer this simple question:
What is "four hundred" as a number?

FIN - Request for Check/Payment to student

FIN - Request for Check/Payment to student

Please be advised that we are a tax exempt entity, and should not be paying tax on purchases. Refer to the procurement guidelines if you have any questions.