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
*
include decimals for partial hours
Rate/Additional Rate per Hour
*
Compensation
$
For class
*
Please Select
Preschool
K-8
Teacher Subbing For
Would you like to add another instance?
*
Yes
No
Date Substituted
*
/
Month
/
Day
Year
Date
Number of Hours
*
include decimals for partial hours
Rate/Additional Rate per Hour
*
Compensation
$
For class
*
Please Select
Preschool
K-8
Teacher Subbing For
Would you like to add another instance?
*
Yes
No
Date Substituted
*
/
Month
/
Day
Year
Date
Number of Hours
*
include decimals for partial hours
Rate/Additional Rate per Hour
*
Compensation
$
For class
*
Please Select
Preschool
K-8
Teacher Subbing For
Would you like to add another instance?
*
Yes
No
Date Substituted
*
/
Month
/
Day
Year
Date
Number of Hours
*
include decimals for partial hours
Rate/Additional Rate per Hour
*
Compensation
$
For class
*
Please Select
Preschool
K-8
Teacher Subbing For
Would you like to add another instance?
*
Yes
No
Date Substituted
*
/
Month
/
Day
Year
Date
Number of Hours
*
include decimals for partial hours
Rate/Additional Rate per Hour
*
Compensation
$
For class
*
Please Select
Preschool
K-8
Teacher Subbing For
Would you like to add another instance?
*
Yes
No
Date Substituted
*
/
Month
/
Day
Year
Date
Number of Hours
*
include decimals for partial hours
Rate/Additional Rate per Hour
*
Compensation
$
For class
*
Please Select
Preschool
K-8
Teacher Subbing For
Total Hours and Compensation
Total Compensation
$
Submitted by
Supervisor
*
Please Select
Rabbi Pekier
Tamar Geldman
Jenny Quinn
Morah Vered
Other
Email Address
*
example@example.com
Full Name
*
First Name
Last Name
Supervisor Signature
*
Today's Date
*
/
Month
/
Day
Year
Date
Form Submitted By:
*
Submit
Should be Empty: