Series 402.3.3.1.2P - Event Worker Voucher Form

EVENT WORKER VOUCHER FORM

This form collects information on individuals who provide services to District 196 in order to process payment for the service. The information collected will be used and maintained within the district by staff responsible for overseeing the services provided and/or staff responsible for ensuring proper payment. It may also be shared as permitted by state and federal law, including federal and state tax law. You are required to provide the requested information in order to receive payment.

EMPLOYMENT STATUS:         _________ ISD 196 Employee (PAYROLL)

                                                _________ Independent Contractor (IC)/Non-Employee (ACCOUNTS PAYABLE)

*Independent Contractor (IC)/Non-Employee Questions Only                                

DEMOGRAPHIC INFORMATION

Full Legal Name: ____________________________________________________________________________

Address/School/Dept: _______________________________________________________________________

Phone Number: ____________________________________________________________________________

Email Address: _____________________________________________________________________________

Employee/Payee Number (if known): _______________________________

*Has the IC worked (and been paid) by ISD 196 in the past three (3) years?       Yes                    No

*W9 Status with ISD 196 (circle one):    On File at the DO         Need to send a new W9           Unsure

*SSN (Last Four Digits): ________________

EVENT INFORMATION (For non-athletic events, please fill out relevant information)

Date of Event: ________________________

Home School: _____________________________________Opponent: _______________________________

Gender:      Boys       Girls         Coed                Activity: _____________________    Level(s): ________________

Role: ____________________                              Time in:                            Time out:                                   

Notes from Worker (if any): ___________________________________________________________________

Signature: ___________________________________________________Date: _________________________

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FINANCIAL INFORMATION - OFFICE USE ONLY

Total Amount: $____________________ Account Code(s):  _____-_______-_______-_______-_______-_____

Pay amount calculation (hours x pay rate):                                                                                                

Notes from School Office:_________________________________________________

Approver: ________________________________   Date of Approval (Submit to Pay): _______________

ACCOUNTS PAYABLE/PAYROLL PROCESSING

Date Voucher Received ___________________________    Date Voucher Paid ______________________

Procedure 402.3.3.1.2P/11-26-19