Series 402.3.3.1.2P - Event Worker Voucher Form
Adopted: April 2019
Revised: November 2019
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: _________________________
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