Payroll Change Authorization for Stipends
Employee Name
Employee ID
Department
Position/Title
Type of Change
New Stipend
Change Stipend
End Stipend
Effective Date
Stipend Amount
Frequency
One-Time
Monthly
Bi-weekly
Other
Account/Fund Number
Reason/Justification for Stipend
Supervisor Signature
Date
Department Head Signature
Date
HR/Payroll Signature
Date