Artemis ROADS PD Stipend Form

Please fill out this short form and upload a complete W9 form to receive a stipend check for the Artemis ROADS professional development workshop.

W9 Forms can be downloaded at: https://www.irs.gov/forms-pubs/about-form-w-9

For us to send you a check, the W9 form needs to be complete and include:

• Name
• Address
• Signature (not typed)
• Social Security Number

Name *

First

Last

Email *

What Artemis ROADS PD did you attend? (Virtual, MT, AZ, etc) *

What is the date of the PD? For multi-day events, indicate the first date. *

Address for mailing stipend check *

Address Line 1

Address Line 2

City

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Zip Code

To receive stipend, please upload your complete W9 form (clear jpg or pdf). Forms *

Click or drag a file to this area to upload.

Form can be downloaded from IRS at https://www.irs.gov/forms-pubs/about-form-w-9. Please make sure your form includes: a signature (do not just type it in use a digital pen or print and sign), your full name, your address, and your social security number. We cannot process incomplete W9s.

If you live in a state (not MT, OR, or WA) that uses a form to verify teacher participation in continued education, please upload it here. (Optional)

Click or drag a file to this area to upload.

If you live in a state (not MT, OR, or WA) that uses a web form to verify teacher participation in continued education, please paste the URL below. (Optional)

Submit