Accounts Payable Forms	Accounts Payable Tel No (818) 677-3472 Fax No: (818) 677-4581 Mail Drop: 8202
	Student Stipend Form

Please process a student stipend (non-compensatory) for the program in the amount of $ .

The student information is as follows:

Name:   Home Address:

Student ID:   Student Email Address:

RESIDENCY STATUS: (Mandatory - Check one only)
* U. S. Citizen	* Resident Alien (Green-card holder)	** Foreign National

Please use the following chartfield string:					REQUISITION NO:
ACCOUNT:	FUND:	DEPT ID:	PROGRAM:	CLASS:	PROJECT/GRANT:	AMOUNT:

Name of Authorized Approver:
Signature: ______________________________________	Date: __________
Print Name:	Ext: __________

* Stipends are reportable income for which a FORM 1099 will be issued.

** 14% withholding will be required. Form 1042-S will be issued.

Signature of Payee: _______________________________	Date: __________
Attachment: Vendor Data Record Form