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Flexible Learning

Stipend Approval Form

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Faculty/Department Requestor Information

*Faculty or Department Name:
*Submitted by:
*Requestor email:

Course Information

*Subject: *CRS Number: *Section: CRN Number:
*Term of Course: Fall Winter Spring/Summer *Year (YYYY):

Personal Information

*First Name:
*Last Name:
*E-mail Address:
*Mailing Address:
*Primary working location:
*Employee/Contractor: Teaching/Lab Assistant Instructor Fellowship Appointment

Additional notes

*Authorized By (Name and Title):

The University of Regina collects information under the authority of The University of Regina Act and in accordance with the Local Authority Freedom of Information and Protection of Privacy Act and the Personal Information Protection and Electronic Documents Act for purposes of the administration of the University and its programs and services. By responding to this form, you are consenting to the University of Regina using your personal information to complete your request.

* denotes required field