Salaried Employees

If you have any questions, please call the Payroll Office at extension 4314.

This site is secured by DigiCert for your protection.

SSL WildCard


Employee Information
(Please fill out the information below; please do not use "enter" key)

Your First Name:
Your Last Name:
Semester Information
Spread equally during
the following term(s):
Spring (Jan.-May)
Intersession (May)
Summer I (June)
Summer II (July)
Fall (Sept.-Dec.)
Comments:

Students Attending

1st Student Name:
Student Banner ID:
(H number)

Academy Student University Student

2nd Student Name:
Student Banner ID:
(H number)

Academy Student University Student

3rd Student Name:
Student Banner ID:
(H number)

Academy Student University Student

4th Student Name:
Student Banner ID:
(H number)

Academy Student University Student

5th Student Name:
Student Banner ID:
(H number)

Academy Student University Student

6th Student Name:
Student Banner ID:
(H number)

Academy Student University Student
I hereby certify that this is my request for this school semester. As a certification for the information listed above, my H number on my ID will act as my signature.
Your H number:

(example: H00011111)
Before submitting your form, please print a copy of this page for your records.