Sample Visa Extension by zbq42493

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									                                                                     INSTRUCTIONAL PERSONNEL ACTION REQUEST FORM



1. College/Division:          MCCAMC                                                                   Date:         July 23, 2007
2. Empl ID #:        100012346                                      Record #:          0               Empl Position #:    997380001

3. Reports to (name):           Yolanda A. Brown                                          Reports to (position #):     997390000


4. Name:                         x        Mary                                                S           Doe
               Mr.      Ms.     Dr.       First Name                                          MI          Last Name


5. Action Requested:          (Example: 12-Month Department Chair Teaching in Summer)
      12-Month Department Chair Teaching in Summer 2007, Session 01 - ART 360
      Summer Session 01: AY Base Salary = $5,469, Unit Rate = $2,188, Total Summer Salary = $6,564.



6.       Part-Time       x Full-Time              GA                 TA             ISA                   Rehired Annuitant                 FERP               PRTB

                                         Job Classification/Grade                 Academic Year/12-Month/Monthly                           Department
7. Current                               Professor, Dept Chair                                12 Month                                          ART
Information
8. New/Changed
Information
                                                         Transaction      Appt/Leave
Job #1                         Dept ID      Job Code    Effective Date     End Date            Rank          Paid Units*   Time Base       Base Salary     Actual Salary

9. Current Information

10. New/Changed               10094         2457         06/04/07         08/17/07                 5           3.000                        $2,188         $6,564.00
Information

Job #2                         Dept ID      Job Code    Effective Date    End Date             Rank          Paid Units*   Time Base       Base Salary     Actual Salary
11. Current                                                                                                                                                  $0.00
Information
12. New/Changed                                                                                                                                              $0.00
Information
13. Transitional Leave Balances:           Sick_______        Vacation_______     PH_______
                                                                Lines 14 & 15 For Faculty Affairs Use Only
14. Remarks:         $6,635 - $346 Stipend = $6,289 / 1.15 = $5,469
$5,469 x 12 = $65,628 / 30 = $2,188
$2,188 x 3 units = $6,564
15.                                   Payroll Return Date:                          Anni Date:                                 Visa Type
                                      Probation Code:                               Final Anni Date:                           Visa Expiration
                                      Probation Ending Date:                        Remaining SSI's:                           (2481) Admin. Fraction:
                                      Sabbatical Elig. Date:                        PRTB End Date:                             Appt Duration:
                                      DIP Eligibility Date:                         FERP End Date:                             PIMS Tran Code:
APPROVALS:
                     Name (Please Type or Print):                    Signature:                                        Date:           Extension:         Mail Drop:

Prepared By:         A. Coordinator                                                                                                          5500            8300
Dept Chair:          C. MAR                                                                                                                  5500            8600
Dean/MAR:            Y. Brown, Dean                                                                                                          4441            8236
Faculty Affairs:                                                                                                       Date To HR:
          ~ Submit Completed PAR Form to Faculty Affairs by the 10th of the Month to meet Monthly Processing & Payroll Cut-Off Deadlines ~
                                        * Complete for Part-Time Faculty and Teaching Associates Only


       FA:fa9b557b-2dc7-476b-8ad3-68166cb9b9b8.xls                                                                                                       8/8/2011

								
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