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Yale Student Employment University Office

Federal Work-Study Community Service Authorized Timesheet Signers

Agency Name Name of the Off-Campus Organization

Required Primary Contact Information:

Name

Address Phone Fax Email

Authorized Signers: We understand and agree to the terms and conditions for time-keeping and reporting. We understand that we are authorized to sign timesheets for students and that we are responsible for the accuracy of information on such timesheets.

______Print Name of Chairperson/Director/Manager Signature of Chairperson/Director/Manager

______Name of Additional Authorized Signer (print) Signature

______Name of Additional Authorized Signer (print) Signature

______Name of Additional Authorized Signer (print) Signature

______Name of Additional Authorized Signer (print) Signature

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