ADMIN PREMIUM REQUEST FOR PAYMENT

ADMIN PREMIUM REQUEST FOR PAYMENT
Name*

First NameLast Name
Email*
example@example.com
Date*

MonthDayYear
Date
Eligible Activity

Summer SchoolAfterschool ProgramClass Coverage/Loss of Planning Period - Loss of Lunch PeriodExceeding IEP Case Manager LimitCompensatory EducationEnrichment/TutoringAdditonal School TIme ProgamsTeaching & Learning Curriculum DevelopersTeacher and Principal SelectionProfessional DevelopmentSchedulingBefore and Adter School AcitivitesECE Family VisitsOther
Activity Description:*
Briefly describe the responsibilities to be completed.
Who approved the activity?*

Principal RosadoAP MooreMr. Robertson
Hours Spent of the Activity*
Signature*

Clear
Should be Empty: