Common Contracts
1 similar Stipend/Human Research Subject Payment Request Form contracts
ContractStipend/Human Research Subject Payment Request Form • December 1st, 2014
Revised 3/2013 Virginia State University Stipend/Human Research Subject Payment Request Form Date: BANNER\Index/Account FOAPAL X1418 Amount: Funding Source(Check One) State Funds Federal Grant Funds Local University Funds (School, Department or Activity) Department Phone Number: P O Box Start Date: Grant Name:/MOU Agreement with: End Date: Purpose: Copy of Grant page or Justification authorizing Stipend Attached? Yes BANNER fund/account Pool budget available Yes (X1400) Completed and signed W-9 Attached Yes Is the Payee a current VSU Employee: Yes No (Employees are not eligible for Stipend Payment) Is the Payee a current Student: Yes No (Stipend form is used only for students) Student/Payee Name: Student V Number/SSN Mailing Address: Requested By: Date: Grant PI or Responsible Party Approved By: Date: School Dean or Vice President Approved By: Date: Office
