Student Pay Rate Change Request Form

Requestor Full Name

Requestor Email

Request Key Words

3-4 Key words to help you search for this request once submitted using (ctrl+F)

Partner Unit

Employee Full Name

Employee 95#

Job Title

Current or new if changing with pay rate increase

Suffix

If multiple jobs within a position, this identifies which job. Such as 00, 01, 02

Current Pay Rate

New pay rate

Effective date

mm/dd/yyyy

Retropay/MCR

Yes

Additional Information

Provide any additional information regarding this request

File Upload

If you have more than one student pay rate change, upload a spreadsheet with the complete information.

Drop your files here

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