ED-47 (REV. 8/04)
                                       STIPEND CONTRACT
Requisition #:                          Account Information (FIMS):                   -             -      -
Vendor #:                                                                     PC:             Grant ID:

I,                                                                                                         of
                                       (complete name)

                             (complete address, including street, city, state and ZIP code)

agree to receive an education stipend for training/participation, as described below, from the
                                                                       , at
                     (organization name)                                                  (location)

                                                    (brief description of event)

Date(s) of training:       From:                                               To:

The stipend shall be $                              per                       not to exceed $

Authorized travel expense:
    Will not be reimbursed.
    Will be reimbursed upon proper documentation in accordance with the travel
    regulations of the Agency not to exceed $                       .

Please check the appropriate box below:
     I am not currently a full-time employee of the State of West Virginia.
     I am currently a full-time employee of the State of West Virginia. (See certification below)

WV DEPARTMENT OF EDUCATION                                     VENDOR

Division Signature                                             Vendor’s Signature

Executive Director, Office of Internal Operations              Taxpayer Identification Number (SSN/FEIN)

Date                                                           Date

FUNDING INFORMATION – Stipend received under this contract will be continued in the
succeeding fiscal year, beginning July 1, contingent upon funds being appropriated by the
Legislature for this stipend. In the event funds are not appropriated for this stipend, this contract
becomes of no effect and is null and void after June 30.

CERTIFICATION: Full-time employees of the State of West Virginia must complete.
It is hereby certified that the stipend to be received under this contract will not interfere with or
detract from the full-time duties of the employee. The amount of annual compensation
received by                                             (above named vendor) from the State of West
Virginia for full-time employment during the current fiscal year will be $
The vendor serves as                              With the title of

 Signature of Vendor’s Supervisor/Agency Head:
                                  Agency name:

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