Ball State University
School of Nursing

Clinical Supervisor Payment Form

I have moved since the last time I requested paymjent as an independent contractor serving as Clinical Supervisor for the Ball State University School of Nursing.
NO YES

All payees are required to have a current W-9 on file with the University. No payments can be issued without a current W-9 on file. Please download and complete the form now. Once you have completed the form, please mail only the first page to the address noted on the form.

After completing the W-9 form, please continue by filling out this form.

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Student Name	Course Number	Section Number	Semester	Year

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