Cell Phone Stipend Authorization

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Cell Phone Stipend Authorization Powered By Docstoc
Employee Name: __________________________________
Job Title:          __________________________________
Department:         __________________________________
Account Number to be charged: ______________________
Date cellular service to begin: _ _/ _ _/ _ _
Cellular phone number: (_ _ _) _ _ _- _ _ _ _

A cell phone stipend of $75 per month will be given to employees required to have a cell
phone if approved by both the Department Supervisor and the Department VP. The
stipend will be used toward the employee’s purchase of a monthly plan, phone and any
other accessories. The stipend will be reimbursed to employees through the payroll
system and will be considered taxable income. Payment will be made as an addition to
the employee’s payroll check. Note that the stipend does not constitute an increase in
base pay and will not be included in any percentage calculations for increase to base.
This application must be filled out and submitted to your immediate supervisor. Your
supervisor will submit to the departmental VP for approval. It is the responsibility of the
supervisor to notify payroll of any change in status.
Stipends expire at the end of each fiscal year, May 31. Use the form to renew as
Employee Certification and Signatures:
I certify that I will use the funds requested toward cell phone business use and will
promptly report any changes in the level of those cell phone business expenses to my
supervisor. I further certify that I have read, understood and intend to comply with the
Assumption College Cell Phone Reimbursement Policy.
Employee Signature:      __________________________       Date: __________
Dept. Supervisor Signature: _______________________       Date: __________
Justification: __________________________________________________________

Authorized Approval
Departmental VP Signature: _______________________                                Date: __________
Retain a copy of this form and route to the Payroll Department. Attn: Deb Daly

For Office Use Only
Payroll Office: Start date of reimbursement: __________ End date: __________
                Reimbursement amount per month $____________