Career Services
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State Work-Study Employer Information Change Request

 
Employer Name (required)
 
Employer Federal Id Number (required)
Business name and Federal Id number must match current State Work Study contract.

Employer Information

This form cannot be used for a Federal ID number change. A new contract must be submitted to the school.

New Employer Name
 
Telephone Number (required)
() -  -   

New Contact Person

New Address
 
Date Changes Take Effect
 /   / 

Pay Rate Information

The HECB reviews pay ranges that exceed $25.00 per hour. The wages need to be comparable to what they would pay a non-work-study student performing the same job duties. This form cannot be used if the job title or job duties change. A new job description must be submitted to the school.

Name of Student's School

Position Number

Job Title

Old Pay Range
$ to $
 
Ending Date
 /   / 

New Pay Range
$ to $
 
Beginning Date
 /   / 
 
Comments
Please type your name below to represent your authorized signature.

Employer Signature

Current Date
10/31/2020