handbook for cooperating teachers - Wilmington University

.COOPERATING TEACHER STIPENDIn order to process your Cooperating Teacher stipend, we request that you complete this formand the attached W-9 (Part I. Tax Identification Number). The TIN form is required by the IRS.Stipends forms are processed at the end of the semester.DATE:STUDENT’S NAME:SEMESTER:COOPERATING TEACHER:HOME ADDRESS:CITY STATE ZIP:HOME PHONE:COOPERATING TEACHER SIGNATURE:SOCIAL SECURITY NUMBER:ARE YOU CURRENTLY A WU ADJUNCT FACULTY MEMBER? (circle one) yesnoFOR OFFICE USE ONLYEVAL RECEIVED:EVAL RECEIVED BY:College of EducationProfessional PartnersCreating Environments for Learning135August 2011