Authorization for Payment of Departmental Scholarships

Authorization for Payment of Departmental Stipends Summer Awards (Enter Aid Year)

Please type required award information on this form and email a signed PDF copy to [email protected].

Stipend Name Item Type Number College Department

Organization Department (9.2) Fund Category (9.2) Fund (9.2) Function (9.2) Project ID (9.2) Program (9.2) Purpose (9.2) Site (9.2)

Career Credit Hour Requirements Undergraduate (UG) Graduate (GR)

Account Manager Certification Statement: I hereby certify that payment is to be made on the above-named account for a STIPEND for the named individual: for tuition, books and living expenses; that this payment or series of payments does NOT represent wages (compensation) for work performed or services rendered to the University of North Texas, and that there is no employee/employer relationship represented by the referenced stipend payment(s).

Name of Authorized Account Manager Signature and Certification of Authorized Account Manager Date Phone / / ( ) -

Name of Authorized Contact Representative(s) Signature of Authorized Contact Representative(s) Date Phone / / ( ) - / / ( ) -

Signature of Approving Research Administrator Name of Approving Research Administrator Date Phone (required to process grant awards*) / / ( ) - *Project ID accounts require Research Administrator approval.

Revised 06/2016 Authorization for Payment of Departmental Stipends Summer Awards (Enter Aid Year)

Please type required award information on this form and email a signed PDF copy to [email protected].

Stipend Name Item Type Number College Department

Organization Department (9.2) Fund Category (9.2) Fund (9.2) Function (9.2) Project ID (9.2) Program (9.2) Purpose (9.2) Site (9.2)

Comments Monthly Begin Date End Date New Revise Cancel Student Name EMPLID Total Amount (Make note of Credit Hour Amount (Month/Day/Year) (Month/Day/Year) Award Award Award Exceptions, etc.)

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

Revised 06/2016