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Shippensburg Area
Payment Request - Sports
9/22/2021

Name: *

School: *

Sport: *

Full or Half Pay:

1 - full pay, .5 - half pay

Contract Amount: *

Total Pay:

Dates/Hrs of work:

not required for salaried supplementals

*** Below fields will be completed by payroll ****

Account Number:

percent:

Account Number:

percent:

Account Number:

percent:

Account Number:

percent:

Pay Date:

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