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Participant Agreement and Payment Request Form
(Non-RIT Student)
I,
agree to participate in the
Participant name
Program name
I understand the following Program Requirements:
As a participant of the program I understand the following additional requirements and confirm:
I understand the stipend and any other support received through this program is taxable income and will be reported to the IRS
annually as follows: Non-Resident Alien Participant: May be subject to 14% withholding based upon tax treaty and reported on
Form 1042-S. All Other Participants: No withholding, reported on Form 1099 (if payments exceed $600 in a calendar year).
Stipend Details:
Oracle General Ledger Account:
Payment Amount
.
Object Code 75700
Academic Term:
(circle one)
Participant's Status:
(choose one)
Fall
Spring
Summer
.
XXXXX.
.
.
00000
N/A - Program Dates____________________
U.S. Citizen or Permanent Resident/Green Card Holder or
Non-US Citizen
NOTE: U.S. Citizenship or permanent residence may be required to be eligible to participate in federally funded REU or
experiential programs (e.g. LSAMP, McNair).
Participant Signature
Date
Participant Email
PI Signature /
Approver Signature
Date
SPA Signature
(if applicable)
Date
Dept. Contact (print)
Ext:
Remember to attach a completed W-9 form with your request!
Participant Agreement and Payment Request Form (Non- RIT Student)