SUBJECT FEE PAYMENT REQUEST FORM THE UNIVERSITY OF MICHIGAN

  SUBJECT REASONED OPINION (SUBSIDIARITY) ON THE REGULATION
REC ITUR BT7103 15 RECOMMENDATION ITUR BT7103 SUBJECTIVE ASSESSMENT
23 DATE FEBRUARY 23RD 2009 SUBJECT APPLICATION

APPLICATION FOR DESIGNATION OF NOT HUMAN SUBJECTS
CONTRACT TEACHING FACULTY SELF EVALUATION GUIDELINES 1 SUBJECT
FREUNDESKREIS ASYL 89269 VÖHRINGEN SUBJECT HEATING

SUBJECT FEE PAYMENT DOCUMENTATION FORM


SUBJECT FEE PAYMENT REQUEST FORM

THE University of Michigan



Please indicate the preferred method of payment:

1) Check issued via M-Pathways system

2) Check issued by University Cashiers Office

3) Cash issued by University Cashiers Office

TO BE COMPLETED BY DEPARTMENT

Participant

Date: Vendor ID#


University Department:


Departmental Contact Person:


Departmental Telephone Number:


Departmental Reference Number (optional):


Amount: $

Written Amount: Dollars

I certify that the terms, restrictions and qualifications set forth in this form’s administration policy are met and that the payments are in compliance with all conditions imposed by the funding source.


Name Printed: Authorized Signature:


Account (6)

Fund (5)

Dept (6)

Program (5)

SubClass (5)

Project/Grant







TO BE COMPLETED BY PARTICIPANT



Participant’s Printed Name Participant’s Signature


Street Address City, State, Zip


Participant’s Social Security Number

□ Mail payment to volunteer at the above address.


□ I hereby acknowledge that I have received the above

described amount as full payment for my participation. _______________________________________

Participant’s Signature


Forward voucher and attachments to:

Accounts Payable

5091 Wolverine Tower – 1287

734 764 – 8212


SPG 501.7

Rev 7/09



FROM IPPC SERVICES SUBJECT IPP TRAINING WORKSHOP –
HOSPITAL MEDICAL STAFF POLICY SUBJECT DISRUPTIVE BEHAVIOR
SUBJECT AREA GRADE 9 GRADE 10 GRADE 11


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