ROADS Professional Development Stipend Request 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.

Name *

First

Last

Email *

Phone

Where did you attend the ROAD Professional Development (virtually, MT, AZ, etc) *

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

Information on Completing W9 Forms

NESSP must report stipends paid to the educator to the IRS. Please download a blank W9 form from the the IRS website:

W9 IRS Form

The following fields are required:

full name,
current address (where check will be mailed),
social security number,
signature, and
date.

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.

Address for mailing stipend check *

Address Line 1

Address Line 2

City

State

Zip Code

ROADS Professional Development Stipend Request Form

Information on Completing W9 Forms

Announcements