Stipend Proposed Change in Staffing
Name of person completing form *
Your answer
Staff member LAST name *
Your answer
Staff member FIRST name *
Your answer
Type of Employment *
Type of Change *
Reason for Change *
Your answer
Effective Date *
1/1/2012
Your answer
Replacement For *
Your answer
Building Description *
FTE *
FTE of Position
Stipend Assignment Description *
Stipend Title
Your answer
If you chose 'Other' please indicate exact FTE
Ex. .671 FTE
Your answer
Department *
If you chose 'Other' please indicate department
Your answer
Lane *
Your answer
Step *
Your answer
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