LUSKIN School of Public Affairs

GRADUATE STUDENT RESEARCHER (GSR) AUTHORIZATION AND CHANGE IN STATUS FORM

TO: Human Resources Office, 3240 Luskin School of Public Affairs BuildingHR Approval: ______

5 Days PRIOR to Appointment Start Date

Deans Adm Luskin Public Policy Social Welfare Urban Planning School-Wide ______

1180 3020 1182 0350 1184 1181

PLEASE NOTE: Authorizations for all new hires / rehires must be submitted to the Business Office 5 working daysin advanceof requested begin date

EMPLOYMENT STATUS / CHANGE IN APPT/DIST / CHANGE IN PAY RATE / POSITION CHANGE / LEAVE / TERMINATION
New Hire / Change in Fund Source / Step Increase / To GSR fromTA Appt / Personal / FMLA
Rehire / Change in % Time / Advancement to Candidacy / To GSR from Reader Appt / Separate
Additional Appointment / Extend End Date / Written Justification / To GSR from Staff / End of Appt. ______
Student Information:
Name / UID/Student I.D. # / - / -
Your E-mail Address / Home Phone / ( )
Prior/Current UCLA Employment:No If Yes Indicate Department & Contact:
Title / Title Code / Step
Appointment Begin Date / Appointment End Date / Appointment % Time
Rate Of Pay: / $

Monthly

If above 50% time is requested a letter of justification from the chair of the student’s academic department should state the need for the exception and describe the student’s academic standing in reference to other students at the same stage in their graduate careers. Please submit all “exception letters” to Graduate Division with a cc to Human Resources.
Student may work up to full-time during inter-quarter periods and during the summer (please check box if applicable only)
 Students who hold GSR appointments in another department may be eligible for Fee Remissions if both equals 25% or more
ACCOUNT DISTRIBUTION: / THIS SECTION IS FOR FUND MANAGER USE ONLY
Account / CC / Fund/ Sub / Percent
Allocated / Dist.
Begin Date / Dist.
End Date / Increase Decrease
% Time / Add / Delete / Change / Fund Mgr
Approval / Date
1. / – / –
2.
3.
4. / – / –

Pay rates for Graduate Student Researchers are based on degree level and prior experience as documented on the “biography for Graduate Students” which must accompany this authorization for new appointments, rehires, step increases and advancement to candidacy. (Steps 1 – 10 )

Appointment eligible for Fee Remissions  Yes  No

If Yes, please attach Fee Remissions Application and Statement of Understanding

Approval Signature:______Date: ______

Unit Head or Principal Investigator

Employee’s Signature: ______Date: ______

Revised June 2011BRiley