Lehigh University Payroll Office

Lehigh University Payroll Office

Graduate Fellowship Income Tax Withholding Request Form

For Use By U.S. Citizens and Resident Aliens Only

This form can be found on the Controllers Office web site under “Payroll Forms”

Complete all boxes on the Income Tax Withholding Request and sign and date the Request. A completed Request is necessary ONLY if you desire to have income tax withheld from your graduate fellowship payments. Please refer to the federal rate schedules for the current calendar year as found on the Payroll Section of the Controllers Office web page or in Publication 15 on the IRS web site (www.irs.gov). These tables indicate the tax rates applied at various levels of taxable income. Please keep in mind that your personal tax situation will affect the final amount of your overall personal tax liability. Lehigh University does not render personal income tax advice. You may want to consult with your personal tax advisor on this matter.

First Name: / Last Name:
Social Security No: / Phone Ext: / Email:
Amount of FEDERAL income tax you want withheld from each semi- monthly fellowship payment:
Additional withholding will commence with first regular pay cycle following Payroll Office receipt of this form. / $ / *This additional amount will terminate at the end of your current fellowship appointment. Resubmit a new form for subsequent appointments.
Signature: / Date:

Return this form to:

Payroll Office

524 Brodhead Avenue

I:Forms\Payroll\Graduate Fellowship Withholding Request.doc