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Off-Campus Work-Study Employers
OFA - Work-Study Off-Campus Job Certification
OFA - Work-Study Off-Campus Job Certification
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Off-campus work-study employers should use this form to designate U-M Ann Arbor student hires as work-study employees and initiate access to federal work-study funds.
This form should be completed by the person authorizing funds for this position.
Student Information
Student Name
Provide the first and last name of the student.
Student UMID
Has the student completed the Student Employment Application in Wolverine Access?
If the student has not completed the employment application, do not proceed with this form.
Has the student completed the Student Employment Application in Wolverine Access?
Yes
Work-Study Term
Work-Study Term
Fall and Winter
Fall
Winter
Spring/Summer
Academic Year
Academic Year
2023-2024
2024-2025
Review
important dates
for Fall, Winter, and Spring/Summer employment periods.
Work-Study Award Amount
Provide the amount of work-study aid the student was packaged with.
Student's Job Title
Job ID
Provide the job ID or job posting number.
Hourly Pay Rate
Effective Date
(mm/dd/yyyy)
Employer Information
Agency
ANN ARBOR AREA TRANSPORTATION AUTHORITY
ANN ARBOR ART CENTER
ANN ARBOR COMMUNITY ACUPUNCTURE
ANN ARBOR YMCA
APPLE PLAYSCHOOLS
BNAI BRITH HILLEL FOUNDATIONS INC
COMMUNITY ACTION NETWORK
DOMESTIC VIOLENCE PROJECT INCORPORATED
ECOLOGY CENTER INCORPORATED
FRIENDS OF THE UNIVERSITY OF MICHIGAN GILBERT AND SULLIVAN SOCIETY
HURON RIVER WATERSHED COUNCIL
INTERNATIONAL HOUSE ANN ARBOR
JEWISH FAMILY SERVICES OF WASHTENAW
MIRCORE
NATIONAL WILDLIFE FEDERATION
SYNOD RESIDENTIAL SERVICES
Other (Not Listed)
Other Agency
If your agency was not listed above, please provide it here.
Agency Email
Agency Phone
Supervisor Name
Provide the first and last name of the student's direct supervisor.
Is this a federal agency?
No
Yes
Optional Comments
Any additional details that might help us process this form may be added here.
Press Alt + 0 within the editor to access accessibility instructions, or press Alt + F10 to access the menu.
Authorization & Certification
We will pay student wages in full and bill the university at least monthly for the reimbursement rate applicable to the pay period. We will pay the employer’s share of Social Security and Workmen’s Compensation and will issue W2 statements at the end of the year.
We will pay student wages in full and bill the university at least monthly for the reimbursement rate applicable to the pay period. We will pay the employer’s share of Social Security and Workmen’s Compensation and will issue W2 statements at the end of the year.
I attest to the statement above.
Federal agencies only: Based on payroll report forms submitted, the university will pay a percentage of a student’s wages and bill the agency for the remaining percentage, including the employer’s share of Social Security for work performed during periods of non-enrollment.
Review the most recent Off-Campus Student Employment Newsletter to determine the percentage currently in effect.
Federal agencies only: Based on payroll report forms submitted, the university will pay a percentage of a student’s wages and bill the agency for the remaining percentage, including the employer’s share of Social Security for work performed during periods of non-enrollment.
I attest to the statement above.
The person completing and submitting this form should be the authorizer of funds for this position.
Confirm this statement and provide your information below.
The person completing and submitting this form should be the authorizer of funds for this position.
I am the person authorizing funds.
Your Title
Other Fields
Your name
Your first name
Your last name
Your email address