Skip to Content - Skip to Navigation

Faculty and Staff Forms

Deferred Compensation EnrollmentDocument icon
 Deferred Compensation Enrollment Form
Deferred Compensation Salary Deferral AgreementDocument icon
Pennsylvania Deferred Compensation Program Form
Direct DepositDocument icon
Please include a voided check with the direct deposit application
Dual Compensation FormDocument icon
Request Form for Dual Employment
Employee's Nonwithholding Application CertificateDocument icon
Application for exemption of withholding of Pennsylvania state tax.  Residents of Indiana, Maryland, New Jersey, Ohio, Virginia or West Virginia should complete this form to have tax withheld for his/her state of residence.
Faculty Pay Schedule for 2014-2015Document icon
Faculty pay schedule for academic year 2014-2015.
I-9 for 2015Document icon
2015 I-9 form to be completed for employment.  Needs to be submitted to the Payroll Office.
Local Services Tax - Exemption Certificate - 2015Document icon
Local Services Tax - Exemption Certificate 2015 - Tax Year Application for Exemption from Local Services Tax
Manager Working From Home Reporting FormDocument icon
Time Reporting form for managers working from home (Excel)
Personal Data Summary SheetDocument icon
Form needs to be completed by non-credit employees only.
Residency Certification Form: Change of AddressDocument icon
This form is to be used by employers and/or taxpayers to report essential information for the collection and distribution of Local Earned Income Taxes.
Savings Bond FormDocument icon
Savings Bond direct deposit authorization form
SCUPA (Full-Time) Time and Attendance FormDocument icon
Time sheet for full-time SCUPA employees
SCUPA (Part-Time) Time and Attendance SheetDocument icon
Time sheet for part-time SCUPA employees
Statement Of Citizenship StatusDocument icon
Please fill this form out yearly if you are a nonresident alien.
Time and AttendanceDocument icon
Time and Attendance Form
Tax-Sheltered Annuity 403(b) Salary Reduction AgreementDocument icon
Enrollment/change form for the Tax-Sheltered Annuity 403(b) plan.
Withdrawal of Consent to Electronic W-2Document icon
Use this form only if you have consented to electronic-only delivery of your W-2 but have changed your mind and now want the State System to send your W-2 via U.S. mail.
W-4 for 2015Document icon
Form W-4, ensures your employer can withhold the correct federal income tax from your pay
  • Payroll Services Office
  • Sutton Hall, Room G11
    1011 South Drive
    Indiana, PA 15705
  • Phone: 724-357-2510
  • Fax: 724-357-7551
  • Office Hours
  • Monday through Friday
  • 8:00 a.m.–4:30 p.m.