High School Certified Employee Request for Salary Credit

CERTIFIED TEACHER

REQUEST FOR SALARY CREDIT

** This must be filled in before courses are approved or up to 14 days after completion of course.
Name (Last, First)
School Email
example@example.com
Building
Today's Date

MonthDayYear
Date
Grade/Subject
Present Salary Position (Lane and Step)
I request permission to take the following courses for graduate credit:

Credit applies only for salary advancement, not for degree advancement.Credit applies towards approved dgree program.

**Starting date for course(s) listed:

MonthDayYear
Date
Summarize each course and the explicit relationship this(ese) courses have to your teaching assignment:
Signature of Supervising Principal
Date

MonthDayYear
Date
Superintendent’s Signature
Date

MonthDayYear
Date
Semester Hours on file before the above course(s)
Number of Semester Hours you have on File. If this information does not coincide with your records, please contact the Central office immediately.
Date of most current transcript on file corresponding to the semester hours on file at Central Office.

MonthDayYear
Date of most current transcript
Should be Empty: