Student Worker Change in Status Form

Student's Name*

First Name

Last Name

Student's CWID*

Change Request*

Approve Change of Status to Campus Employment Terminate Campus Employment Student Employment Terminate Federal Work Study Student Employment

Change to Campus Employment Effective Date *

If you want to change the student between the 1st and the 15th of the month, indicate the 1st. If you want to change the student between the 16th and the end of the month, indicate the 16th of the month.

Department Budget Code*

Campus Employment Termination Effective Date*

If you want to terminate the student between the 1st and the 15th of the month, indicate the 15th. If you want to change the student between 16th and the end of the month, indicate the end of the month.

Federal Work Study Termination Effective Date*

If you want to terminate the student between the 1st and the 15th of the month, indicate the 15th. If you want to change the student between 16th and the end of the month, indicate the end of the month.

Name of Manager Approving Change*

First Name

Last Name

Signature*

[clear]

Use your mouse or finger to draw your signature above

Date Submitted*

FASM

Processed*

Yes No

Comments

Signature*

[clear]

Use your mouse or finger to draw your signature above

Date*

Human Resources

Processed*

Yes No

Comments

Signature*

[clear]

Use your mouse or finger to draw your signature above

Date*

Payroll

Processed*

Yes No

Comments

Signature*

[clear]

Use your mouse or finger to draw your signature above

Date*