Appendix G

For a usable version of this form, please download the PDF of the UF Contract and print this page.

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 _______________________

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