Payroll Claim Form

Payroll Claim Form

Monroe County Community School Corporation
NOTE - A multi-day submission for the same event should be on one form only. Please do not submit multiple forms for the same event.
Employee Name*

First NameLast Name
Employee e-mail address:*

Confirmation EmailPlease type twice to confirm
School/Building*
Code
Supervisor E-Mail*
Note - This depends on your selection for School/Building above
Supervisor E-Mail2*
Note - This depends on your selection for School/Building above
Admin Asst E-mail
Note - This depends on your selection for School/Building above
Employee Type*
Position Title*
Telephone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Payroll Claim Event?*
Event Description*
Intermediate Supervisor email
example@example.com
Event Start Date*

MonthDayYear
Date
Event End Date*

MonthDayYear
Date
Date Range
This looks like a multiple day event! Please list all dates and detailed description(s) per date below.

(ex) 2/10/23 - Tutoring

2/11/23 - Tutoring

Total Quantity To Be Reimbursed*
(ex) 6
Total Reimbursement Rate*
(ex) $20.00
The below field calculates automatically based on the two fields above.
Total Amount to Be Paid*
Do you know the acccount that is paying for this claim?*
If you do not know this account, you must first please contact your building administrator, direct supervisor, or administrative assistant in order to submit this form.
Is this Claim for An Athetics or other Extracurricular Event? (Skyward ECA Account)
Pay from Account*
(ex) 1234 E 1234567 1234 123 123
Confused with your account? Please view this document for additional assistance.
Pay from Account (ECA)*
(ex) 1234 E 1234567 1234 123 123
Confused with your account? Please view this document for additional assistance.
Do you have attachments to justify this claim?

YesNo
Do you have any notes that support this Payroll Claim?
Browse Files

Cancelof
Certification Statement

I hereby certify that the above is true and correct, that the amount claimed is legally due, after allowing all just credits, and that no part of the same has been paid.
Signature

Clear
Should be Empty:

Certification Statement