SYRACUSE UNIVERSITY
MONTHLY STIPEND INFORMATION SHEET
Student Information
Student ID Number -
SSN - -
Student's Last Name:
Student's First Name:
Is recipient a candidate for a degree at Syracuse University? Yes No
     If no, explain:
Student Status: Undergraduate M.S. Ph.D.
Other
Is recipient required to perform services for the stipend now or in the future? Yes No
Is recipient: U.S. Citizen Resident Alien
Nonresident Alien
    Visa Type (required for Nonresident Alien):
Country of Residence:
Stipend Information
Number of Monthly Payments:
Amount per Payment:
Total Amount to pay Recipient: *Amount will calculate based on Number of Payments and Amount per Payment above.
Exact Time Period to be Covered by Payment: -
  (Month)      -    (Year)
Chartstring to be charged:
SPONSORED AWARDS/COST SHARING
FUND DEPARTMENT PROGRAM ACCOUNT MYCODE PROJECT ACTIVITY BUD REF
2 digits 5 digits 5 digits 6 digits 6 digits 5 digits 3 digits 2 digits
Payroll Department: -  (5 digits - 4 digits)
Project Director Information
Name and campus address of person authorized to receive and distribute checks:
Name:
Campus Address: Dept Name
Street Address
Signature in Full of Project Director of Program:  
Pre-Audit Information
Print and Return Form to selected Pre-Audit Department:
Pre-Audit Signature:  
Tax Status Reviewed Signature: