MUST USE AGENCY LETTERHEAD
DATE: Month day, year
TO: The University of Arizona
Office of Student Financial Aid
Federal Work-Study, Admin., Bldg., Room 203
P.O. Box 210066
Tucson, AZ 85721-0066
INVOICE
Employee Name:_______________________________SSN:____________________________
Pay Period Dates:_______-_______ Total Hours Worked:________ Hourly Wage:__________
Total Wages Paid (100%): ___________________ UA Share (75%): _____________________
Employee Name:_______________________________SSN:____________________________
Pay Period Dates:_______-_______ Total Hours Worked:________ Hourly Wage:__________
Total Wages Paid (100%): ___________________ UA Share (75%): _____________________
Employee Name:_______________________________SSN:____________________________
Pay Period Dates:_______-_______ Total Hours Worked:________ Hourly Wage:__________
Total Wages Paid (100%): ___________________ UA Share (75%): _____________________
Employee Name:_______________________________SSN:____________________________
Pay Period Dates:_______-_______ Total Hours Worked:________ Hourly Wage:__________
Total Wages Paid (100%): ___________________ UA Share (75%): _____________________
Employee Name:_______________________________SSN:____________________________
Pay Period Dates:_______-_______ Total Hours Worked:________ Hourly Wage:__________
Total Wages Paid (100%): ___________________ UA Share (75%): _____________________
TOTAL REIMBURSEMENT REQUESTED: $___________________