Student Stipends • Request Form
School of Social Work
University of Pittsburgh
2117 Cathedral of Learning • Pittsburgh, Pennsylvania15260 • (412) 624-6327
Agencies providing paid field placements through the University of Pittsburgh payroll system should complete the information requested below. The completed form can be faxed to (412) 624-6323, but the original must be delivered to Colleen Scholl, Social Work payroll administrator, at 2117 Cathedral of Learning, Pittsburgh, PA15260, along with the student payroll documentation listed on the following page. These items MUST be turned in by the first day of the month in which payment is to be received.
Student’s Name:______
Agency’s Name: ______
Contact Person :______Phone Number:______
Address: ______
______
Faculty Liaison at the School of Social Work: ______
Faculty Liaison or Field Director signature______
Indicate below the months and the amount per month to be paid to the student:
MonthAmount of Stipend
______$______
______$______
______$______
______$______
______$______
______$______
______$______
______$______
Total$______
The student listed above will receive payment on the last day of each month as indicated on this form. The agency is responsible for reimbursement of all payments. Any changes in appointment dates or stipend amount must be made in writing to Colleen Scholl at 2117 Cathedral of Learning, Pittsburgh, PA 15260, by the first day of the month that the change will take place, otherwise the agency is responsible for the stipend payment made to the student. Please sign on the line below as indication of your understanding and agreement to this policy. Thank you.
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Student Stipends • Payroll Information
School of Social Work
University of Pittsburgh
2117 Cathedral of Learning • Pittsburgh, Pennsylvania15260 • (412) 624-6327
All items listed below must be provided to the School of Social Work Payroll office by the first day of the month that payment should be received. All paychecks are issued on the last day of the month. If these items are not delivered in time, payment will not be received until the last day of the following month.
Bring the following items to Colleen Scholl at 2117 Cathedral of Learning
Stipend request form with original signature from agency.
Drivers License
Social Security Card
Voided check for Direct Deposit
Please call Colleen at (412) 624-6327 to make an appointment to drop off the items listed above and to complete the following paperwork:
- Demographic Data Form
- Employment eligibilityverification (I9)
- Direct Deposit Form
Student interns are eligible for health coverage through the University health plan by paying the full premium cost through payroll deduction. The University also makes available a vision plan and a choice of two dental plans, by paying the full premium costs through payroll deduction. Coverage is in force only in months in which a paycheck is received and deductions are made.
Benefit information is attached, please refer to the following website for more information and enrollment:
Please call the benefits office at 624-8160 with any questions.