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Investigator Name & Ext:
Program Manager Name & Ext (if applicable):
Name of Student:
Position: Graduate Student
Current End Date:
New End Date:
Annual Stipend: $
New Annual Stipend*: $
Current Company/Accounting Unit/Activity Numbers & Percent (the stipend can be distributed up to 4 Account/Activity Numbers – example: Example: 2-61-12121-12121-100%)
NEW** Company/Accounting Unit/Activity Numbers & Percent (the stipend can be distributed up to 4 Account/Activity Numbers – example: Example: 2-61-12121-12121-100%) Please also see the link to “Research Instructions – Change of AU & Activity” *INSERT LINK* and send as an attachment to the email
Please confirm that the student is still completing their graduate studies and their work is related to their studies: Y/N
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