Substitute Compensation
Request Form
Is substitute a current employee at the school?
*
Yes
No
Substitute Information
Name
*
First Name
Last Name
E-mail Address
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Description
Date Substituted
*
/
Month
/
Day
Year
Date
Number of Hours
Rate/Additional Rate per Hour
*
Compensation
$
Would you like to add another instance?
*
Yes
No
Date Substituted
*
/
Month
/
Day
Year
Date
Number of Hours
Rate/Additional Rate per Hour
*
Compensation
$
Would you like to add another instance?
*
Yes
No
Date Substituted
*
/
Month
/
Day
Year
Date
Number of Hours
Rate/Additional Rate per Hour
*
Compensation
$
Would you like to add another instance?
*
Yes
No
Date Substituted
*
/
Month
/
Day
Year
Date
Number of Hours
Rate/Additional Rate per Hour
*
Compensation
$
Would you like to add another instance?
*
Yes
No
Date Substituted
*
/
Month
/
Day
Year
Date
Number of Hours
Rate/Additional Rate per Hour
*
Compensation
$
Would you like to add another instance?
*
Yes
No
Date Substituted
*
/
Month
/
Day
Year
Date
Number of Hours
Rate/Additional Rate per Hour
*
Compensation
$
Total Compensation
$
Submitted by
Supervisor
*
Please Select
Rabbi Shlomo Pacht
Dr. Gerard Gindt
Other
Full Name
*
First Name
Last Name
Supervisor Email Address
*
example@example.com
Supervisor Signature
*
Today's Date
*
/
Month
/
Day
Year
Date
Submit
Should be Empty: