Date: __________________

The School District of Philadelphia

Payroll Code Adjustment Request

(Individual Employee)

Employee ID #: ___________________

Requesting School/Department: ______________________________ Telephone #: ___________________

Employee Name: _______________________________________________________________________

Last	First

Employee Position/Title: ______________________________________ (Include appointment ID if applicable)

Date of Absence	Incorrect Code	Correct Code

*Please be sure to include units in H or F with each code.

Log onto www.philasd.org for a complete list of absence codes.

Go to “Employees”

“Payroll Department”

“Payroll Entry”

“Absence Codes”

http://webgui.phila.k12.pa.us/offices/p/payroll/payroll-entry/absence-codes

Authorization: _____________________________________________

(Principal/Administrator)