ContractStipend Payment Request • January 28th, 2015
Revised 3/2013Virginia State University Stipend/Human Research Subject Payment Request FormDate: BANNER\Index/Account FOAPAL X1418 Amount: Funding Source(Check One)State FundsFederal Grant Funds Local University Funds (School, Department or Activity) Department Phone Number: P O BoxStart 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 PartyApproved By: Date: School Dean or Vice PresidentApproved By: Date: Office of Sponsored Program************************************************************************************************** Stipend: A one time
Stipend/Human Research Subject Payment Request FormStipend Payment Request • August 5th, 2021
Purpose: Copy of Grant page or Justification authorizing Stipend Attached? Yes Required Completed and signed W‐9 Attached Yes Required 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 only used for students) Student/Payee Name: Student V Number/SSN Last 4 only Period Services Rendered to
