Request For Employee Stipend Payment Form - El Dorado County Office Of Education
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1EL DORADO COUNTY OFFICE OF EDUCATION
REQUEST FOR EMPLOYEE STIPEND PAYMENT
(*Final authorized stipend form must be received by Payroll
ten (10) days prior to first payment date)
To be completed by Program:
Employee Name
Last
First
Employee I.D. #
Program_______________________________ Primary Position
Program Contact Person/Ext. No.
Administrative Duties
Please choose stipend work to be performed ___________________________________________________
(Contact Personnel Services if stipend is not listed in dropdown)
Please note that the stipend must not be paid for duties described in the employee’s class specification, applicable
negotiated Agreement or the Employee Contract.
Is the stipend to be paid for:____ Certificated (work requiring a credential-contact PS if necessary) _____ Classified
Will this stipend require additional duty time for the employee or is it being paid for enhanced responsibilities during
their normal work schedule? Additional time_____ Enhanced responsibilities______
If yes, provide the following: Approximate number of calendar days in which work will be performed ________
Account Code ____
________
____
_____
____
_______
______
______
Fund
Resource
Year
Object
Goal
Function
Local 1
Local 2
Overall annual cost of the Stipend (fiscal year July 1 through June 30)
$_____________________
Amount to be paid:
$ __________ Daily
$ __________ Monthly
$___________ Annual
Payment to be made:
(Choose only one below)
1._____
Lump Sum:
Payment Date: __________________ (*See note at top of form)
2._____
Monthly: Number of Months: _____
Starting Month: __________
Monthly Amount: ____________
3._____
Installment Schedule Below:
Payment Date__________ Amount__________
Payment Date__________ Amount__________
Payment Date__________ Amount__________
Payment Date__________ Amount__________
Comments:___________________________________________________________________________________
____________________________________________________________________________________________
Authorizations/Routing: (*See note at top of form)
Program Director
Date ______________________
Assoc. Supt./Deputy Supt./Superintendent
Date ______________________
Personnel Services
Date ______________________
Accountant__________________________________________________
Date ______________________
Director of Internal Business
Date ______________________
This Section for Payroll Use Only: Date Received:
Distribution:
Payroll
Employee
Personnel Services
Program
S:\Forms\Request for Employee Stipend Payment 4-2016.doc
Rev. 4-2016
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