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 _______________________

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