Request for Payment

To process your request for payment we will need your Social Security or Tax ID number. Please call us to provide that information. Do not enter it on this form.
For the Ethnomusic Department please contact D.J. Sanchez at (310) 825-4766. For the Music Department please contact Jennie Molina at (310) 206-5184.
* - Required information

Date:(*)
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Name of sponsoring faculty member *(*)
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Name of payee *(*)
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Mailing Address *(*)
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Telephone Number *(*)
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U.S. Citizen or U.S. Permanent Resident *(*)
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If not US citizen or permanent resident, what is your visa type? *
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Type of event *(*)
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Date of Event *(*)
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Explanation *
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Amount to be paid *
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Account # *
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Is payee a UCLA employee? *(*)
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If yes, what is your employee or student ID number? *
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Name of Department *
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% of appointment *(*)
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Department address *(*)
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Campus mail code *(*)
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Payroll/CHR contact person *(*)
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Contact person phone extension *(*)
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Payment Approved by (print name) *(*)
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Payment Approved by (signature) *(*)
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