Student Bursary Request Form
Department Name:
Grant
Funded?
Yes
No
Banner Index:
Grant Award #:
Supervisor responsible for online time
sheet approvals:
Phone:
Financial Manager in charge of budget:
Phone:
Student Name:
Student
Banner ID:
Student Email:
(must be UNH email address)
Check All that Apply:
Full Time
Part Time
Undergraduate
Graduate
Position Start Date:
Position End Date:
Will the student be enrolled during the
employment dates specified above?
Yes
No
Hourly Rate of Pay
Total Hours Allocated
Total Funds Allocated
By signing this form I acknowledge that no student can begin working until they receive a work release card
(pink slip) form the Financial Aid Office.
Financial Manager Signature: ___________________________________________________
Date: ________________________
Student Supervisor:
Date: ________________________
___________________________________________________
Please e-mail completed form to the Budget Department or fax 203-931-6078.
Business Office Use Only:
Approved By: ______________________________________
Date: _____________________________________________
7/24/15