Work Phone. As an employee of Shepherd University, you may contribute a portion of your compensation to the Section 403(b) and/or 457(b) Plan sponsored by the West Virginia Higher Education Policy Commission (“Commission”). The amount that you choose to defer pursuant to Part I below shall not exceed the applicable limitations of Internal Revenue Code Sections 415, 402(g) and 414(v), whichever is less, as applicable. Amounts contributed to the Section 403(b) and/or 457(b) plan will be invested among the approved investment options and selected by you in a separate investment election form. Subject to any advance notice period to process this Salary Reduction Agreement “Agreement” for payroll purposes, this Agreement shall become effective as soon as the form can reasonably be entered following the return of this Agreement to the Shepherd University Human Resources Office. This Agreement replaces any previously submitted Agreement for this plan, and shall remain in effect unless revoked or modified in writing as permitted by the terms of the Section 403(b) and/or 457(b) Plans and in accordance with such form(s) as the Commission and/or Shepherd University may from time to time provide. Please be advised that any election you make below applies only to salary deferrals to the 403(b) and/or 457(b) Plan sponsored by the Commission via Shepherd University payroll contributions. If you participate in another 403(b), 457(b), or 401(k) retirement plan, you should consult your tax advisor regarding the overall limits that apply in your individual circumstances.
Work Phone. As an employee of Pierpont, you may contribute a portion of your compensation to the Section 403(b) and/or 457(b) Plan sponsored by the West Virginia Higher Education Policy Commission (“Commission”). The amount that you choose to defer pursuant to Part I below shall not exceed the applicable limitations of Internal Revenue Code Sections 415, 402(g) and 414(v), whichever is less, as applicable. Amounts contributed to the Section 403(b) and/or 457(b) plan will be invested among the approved investment options and selected by you in a separate investment election form. Subject to any advance notice period to process this Salary Reduction Agreement “Agreement” for payroll purposes, this Agreement shall become effective on the later of the following: (i) the second payroll cycle following the payroll cycle this form is received by the Pierpont Benefits Office; or (ii) as soon as the form can reasonably be entered following the return of this Agreement to the Pierpont Benefits Office. This Agreement replaces any previously submitted Agreement for this plan, and shall remain in effect unless revoked or modified in writing as permitted by the terms of the Section 403(b) and/or 457(b) Plans and in accordance with such form(s) as the Commission and/or Pierpont may from time to time provide. Please be advised that any election you make below applies only to salary deferrals to the 403(b) and/or 457(b) Plan sponsored by the Commission via Pierpont payroll contributions. If you participate in another 403(b), 457(b), or 401(k) retirement plan, you should consult your tax advisor regarding the overall limits that apply in your individual circumstances. ------------------------------------------------------------------------------------------------------------------------------------------------------------------
Work Phone. As an employee of West Virginia University (WVU), you may contribute a portion of your compensation to the Section 403(b) and/or 457(b) Plan sponsored by the West Virginia Higher Education Policy Commission (“Commission”). The amount that you choose to defer pursuant to Part I below shall not exceed the applicable limitations of Internal Revenue Code Sections 415, 402(g) and 414(v), whichever is less, as applicable. Amounts contributed to the Section 403(b) and/or 457(b) plan will be invested among the approved investment options with TIAA. Please be advised that any election you make below applies only to salary deferrals to the 403(b) and/or 457(b) Plan sponsored by the Commission via WVU payroll contributions. If you participate in another 403(b) and/or 457(b) plan or another qualified retirement plan (e.g., WVU Medicine, etc.), you should consult your tax advisor regarding the overall limits that apply in your individual circumstances.
Work Phone. Preferred Email Address (optional) ................................................................................................................
Work Phone. Email address: .......................................................................................................................................................................................................... @............................................................................................................................................
Work Phone. Work email
Work Phone. Cell Phone: We hereby apply to: transfer to / remain at (circle one) High School for the following reasons: Date Date Signature of Parent/Guardian Date Approved Denied Signature of Administrator (If applicable, Sp. Ed. Director) Date Form #156 Approved Denied D.O. Administrator Rev 12/2013 page 1 of 2 “Procedures” on reverse side” Procedures for Intradistrict Transfers 2014-2015 Students who reside in RJUHSD district boundaries are expected to attend the high school in their attendance area. RJUHSD’s open enrollment policy provides for transfers between schools only when space is available at the requested school and there is family transportation for the student. Due to impacted enrollment at several schools, transfers between schools will be reviewed and may be granted when an older sibling concurrently attends the requested school, for the IB Program, when English Learner or Special Education services are required at a different school, or in situations where unique, compelling circumstances are present. DEADLINE: Intradistrict transfers for the 2014-2015 school year will ONLY be considered between January 10, 2014 and February 14, 2014 or within a 15-day period after a student moves from one boundary area to another boundary area within the RJUHSD. Students who apply for and are granted an intradistrict transfer must attend the requested school for that requested school year and will not be able to return to the resident school for that school year. ATHLETIC ELIGIBILITY: Student transfers may affect athletic eligibility. Additional athletic eligibility information is available at xxx.xxxxxx.xxx (Constitution: Article 2, Eligibility Requirements: “Transfer Eligibility,” Bylaw 214). IMPORTANT: A student on an Intradistrict Transfer Agreement is required to maintain good attendance, satisfactory academic progress and proper behavior as determined by the Principal. Attendance problems, discipline problems and/or failure to earn credits toward graduation may be reason to revoke an Intradistrict Transfer Agreement at any time.
Work Phone. Street Address: .....................................................................*City: ..................................... *State:.............. *Zip: .................. *Employer’s Name: ...................................................................
Work Phone. Occupational Group: Married Status: Married De Facto Single Title:……… Surname: ...................................................... Former | Maiden Name:.................................................. Given name: .................................................................... Preferred name: ............................................................. Relationship to student: ................................................. Country of birth: .............................................................. Nationality: ..................................................................... Date of birth:.................................................................... Home Email:..................................................................... Home Phone: ................................................................... Mobile:............................................................................. Occupation:...................................................................... Employer: ........................................................................
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