Requestor Contact Information |
| Name: |
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| Department Name: |
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| Department Number: |
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| Phone: |
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| Email: |
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Student Employee Information |
| Name: |
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| Department Name: |
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| Department Number: |
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| CU Employee ID Number: |
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| New Hourly Rate Requested ($/hour): |
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Justification for Request (Must be based on the complexity of the job duties.) |
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