WSPS Bill for Stipend Services

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West Springfield Public Schools
26 Central Street, Suite 33
West Springfield, MA 01089

Bill for Stipend Services

Please issue check to : Name and home address

For the following services:

Title: Title of Activity

Date(s): Date(s) of activity

Time(s): Hours of participation

Total hours: Total hours to be billed

Total stipend due (total hours x $22): $Total stipend due

Reimbursement will be made via payroll procedures. Contact the payroll department for adjustments on tax deductions.

Payment from account(s): Account number- to be added by Administrator or Business Manager

Signed by employee:

Approval required by Activity Manager or Administrator

Approval by Business Manager

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