Appendix G
APPENDIX G
REQUEST FOR
FACULTY EARLY RETIREMENT TEACHING CONTRACT
(Ref. 14.1.10 of Collective Agreement)
Summary of Teaching Assignment Plan
Name _________________________________ Social Security No._______________________
College _______________________________ Date __________________________________
Department _____________________________ Birthdate _______________________________
Mo Day Year
Evaluation scheduled the following semesters: ______, ______.
INSTRUCTIONAL OR NON-INSTRUCTIONAL ASSIGNMENT
Dept. _________________________ Dept. __________________________
1st Yr. Fall – course _____________________ course _________________________
_________ Spring – course _________________ course _________________________
(Date) Total pay ______________________ other service ____________________
_________ Assignment Completed (Cannot Exceed STRS Maximum)
Dept. _________________________ Dept. __________________________
2nd Yr. Fall – course _____________________ course _________________________
_________ Spring – course _________________ course _________________________
(Date) Total pay ______________________ other service ____________________
Total pay 2 yrs __________________
TOTAL PAY FOR TWO YEARS CANNOT EXCEED ______________ (Two years STRS Max)
_________ Assignment Completed
Dept. _________________________ Dept. __________________________
3rd Yr. Fall – course _____________________ course _________________________
_________ Spring – course _________________ course _________________________
(Date) Total pay ______________________ other service ____________________
_________ Assignment Completed
Dept. _________________________ Dept. __________________________
4th Yr. Fall – course _____________________ course _________________________
_________ Spring – course _________________ course _________________________
(Date) Total pay ______________________ other service ____________________
Total pay 2 yrs __________________
TOTAL PAY FOR TWO YEARS CANNOT EXCEED ______________ (Two years STRS Max)
_________ Assignment Completed
Dept. _________________________ Dept. __________________________
5th Yr. Fall – course _____________________ course _________________________
_________ Spring – course _________________ course _________________________
(Date) Total pay ______________________ other service ____________________
TOTAL PAY CANNOT EXCEED __________________ (STRS Maximum)
_________ Assignment Completed
Employee ____________________________________ Date _______________________
College President ______________________________ Date _______________________
Chancellor ___________________________________ Date _______________________
Board Approval ________________________________ Date _______________________
Department Approval ____________________________ Date _______________________
