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Get Athletic Association Form 104

Athletic Association Ticket Office Entered by All ticket orders are sent to home address. Please include correct ZIP code. Enter Month Day and Year of current continuous service. Only full-time employees eligible. Form 104 Revised 03/09. UNIVERSITY OF GEORGIA ATHLETIC ASSOCIATION Eligibility Certification For Retired Faculty / Staff Athletic Tickets A. Employee Complete and send to department office. Date DOB Last First Middle Title Example Johnson Joseph James Dr. 6-digit CAN Number 810 - - x UGA ID Home Address 1 City State Zip Day Phone B. Department Office Complete and send to Human Resources Date Hired 2 Date Retired Faculty Payroll Type Staff Employment Status3 Monthly or Full Time Bi-Weekly Part-Time Salaried or Hourly Dept. Number School College or Division Account Number Department Name and Telephone No* of person Completing Form Certification I certify that the above employee was paid by my Department From UGA funds including Federal Grants administered By UGA on a current continuous basis. Dean or Department Head Print or Type Approved Signature Date C. Human Resources Complete and return to Athletic Association Ticket Office Approved by Print or Type Name Signature D. Athletic Association Ticket Office Entered by All ticket orders are sent to home address. Please include correct ZIP code. Enter Month Day and Year of current continuous service. Only full-time employees eligible. Form 104 Revised 03/09. UNIVERSITY OF GEORGIA ATHLETIC ASSOCIATION Eligibility Certification For Retired Faculty / Staff Athletic Tickets A. Employee Complete and send to department office. Date DOB Last First Middle Title Example Johnson Joseph James Dr. Employee Complete and send to department office. Date DOB Last First Middle Title Example Johnson Joseph James Dr. 6-digit CAN Number 810 - - x UGA ID Home Address 1 City State Zip Day Phone B. Department Office Complete and send to Human Resources Date Hired 2 Date Retired Faculty Payroll Type Staff Employment Status3 Monthly or Full Time Bi-Weekly Part-Time Salaried or Hourly Dept. 6-digit CAN Number 810 - - x UGA ID Home Address 1 City State Zip Day Phone B. Department Office Complete and send to Human Resources Date Hired 2 Date Retired Faculty Payroll Type Staff Employment Status3 Monthly or Full Time Bi-Weekly Part-Time Salaried or Hourly Dept. Number School College or Division Account Number Department Name and Telephone No* of person Completing Form Certification I certify that the above employee was paid by my Department From UGA funds including Federal Grants administered By UGA on a current continuous basis. Number School College or Division Account Number Department Name and Telephone No* of person Completing Form Certification I certify that the above employee was paid by my Department From UGA funds including Federal Grants administered By UGA on a current continuous basis. Dean or Department Head Print or Type Approved Signature Date C. Human Resources Complete and return to Athletic Association Ticket Office Approved by Print or Type Name Signature D.

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Keywords relevant to Athletic Association Form 104

  • ELIGIBILITY
  • Certification
  • DEPT
  • certify
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  • Revised
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