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 _______________________
