23-24 ESSER Licensed Claim for Wages Payment

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After completion this form will route to the ESSER Coordinator for approval and then be sent to the Administrative Services Office. This form is ONLY for Licensed staff working with ESSER Programs, the Claim for Wages Payment form for non-ESSER related duty can be found on the ISD 316 website under the "Employee Information" section.

First and Last Name *

Employee ID *

Your Employee ID is the number you use to login to ESS (view paystub). If you do not know this number please contact nshepard@isd316.org.

Date of ESSER Program *

YYYY

Hours Per Day *

If not applicable type N/A

Assignment Detail *

Briefly describe the work completed or meeting attended.

Payrate *

$40 (licensed staff rate)

Expense Code

If you do not know this, please leave it blank for the ESSER Coordinator to complete.

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