2/7/2016
Science Education Program
Scholar and Mentor Payroll Time Sheet Verification Form
_______________
Name – TTU/HHMI Scholar (Please Print)
______________
Name – TTU/HHMI Mentor (Please Print)
Please complete the following Mentor information:
TTU, TTUHSC, TIEHH, USDA (circle one)
Department____________________________Building____________________
Other_________________________________________________________________
Mentor Office phone___________________Mentor office room number____________
Lab Phone____________________Lab room number_______________
Campus mail address for mentor_____________________________________
Other email address for mentor, if needed______________________________________
Mentors, Scholars are required to email a screen shot of each bimonthly timesheet to our
CISER Office and ccing that email to the mentor or person(s) assigned by the mentor to
approve timesheets. We will assume approval of all timesheets submitted unless
contacted. Contact Julie Isom, Associate Director, with any concerns or questions.
As mentor for the above indicated Scholar, I assume responsibility for
monitoring the electronic time sheet of this scholar.
As mentor for the above indicated Scholar, I have assigned the responsibility of
monitoring the electronic time sheet of this scholar to the person(s)
listed below. A mentor should approve time sheets in the absence of
the person listed below.
Email (Please Print)
Signature
Signature – TTU/HHMI Mentor
Please return completed forms to Julie Isom as a hard copy or scanned to julie.isom@ttu.edu
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2/7/2016
Undergraduate Science Education Program
SCHOLAR CONTACT INFORMATION and AGREEMENT
PRINT CLEARLY, PLEASE!
Name ____________________________________________Date______________
Fill out the following information and please let us know if this changes at any time!
Address________________________________________________________
City or Campus____________________________ ST ______ Zip ___________
Phone ( _______ ) _________ - __________________ cell
Phone ( _______ ) _________ - __________________ home
If local, is this also your permanent, parent or guardian address? Yes ____ No ____
We will use your TTU email, but if you have an additional email to which you would like
information sent, use the following email address:
*Use all caps and use “0” for the number zero and “o” for the letter o.
Scholar Agreement
I, (Printed Scholar Name)_________________________, agree to uphold all CISER
Undergraduate Research Scholar obligations for research and service while I am an
undergraduate and after graduation, as understood in program materials and from Scholar
Orientation, SSO Weekly email and all other program communications. I also agree to
stay in touch with program staff and/or directors to enable them to help me with by future
endeavors and to support the program for Scholar education and career tracking and
possible alumni service opportunities to CISER and Texas Tech University.
Signed ______________________________
Date ______________________________
(over)