Date Received. Game Management Unit Ranch #
Date Received. E. Disposition by the appropriate administrator or Joint Grievance Committee: (attach additional pages if necessary) Signature Date Name Date In accord with Article VI, Sec. B of the Negotiated Agreement, I hereby request a Sick Leave Grant of days (contract days) for the following condition: Dates I expect to be (or have been) disabled: I have exhausted all my Accumulated Sick Leave (yes or no): Signature of Employee (or other family member-in case of necessity) SICK LEAVE POOL : Grant applications are made by submitting a letter of request to a member of the sick leave pool committee. The applicant must have exhausted all accumulated sick leave. The applicant must demonstrate that a catastrophic or disabling condition exists. The grant application must be made within the contracted year that the condition occurs. The sick leave pool committee shall be the final authority on each grant. The applicant agrees to repay the Sick Pool under the guidelines stated in the Negotiated Agreement. If the applicant leaves the district, still owing days to the Sick Pool, the applicant agrees to a salary deduction at the daily rate during the year they leave the district for each day owed. If the applicant is disabled as evidenced by KPERS disability approval, reimbursement is not expected. Following for Use of Sick Leave Pool Committee: Do not Detach. Name Date Received by Committee Number of Sick Leave Days Accumulated at Beginning of School Year Date Sick Leave Days Exhausted Request Approved for Grant of Contract Days from the Sick Leave Pool. Request Denied: Reason Denied Date Approved or Denied by Committee Signature of Sick Leave Pool Committee Chairperson: School: Educator Name: Grade or Subject: Evaluator: Date: Time in: Time out: ○ Formal Evaluation/Observation Type of Evaluation: ○Summative Evaluation ○Informal Observation Number of Students: ○ Educator Self Reflection Instructions: The evaluating administrator shall complete this part of the Educator evaluation based on the 4 Elements of Effective Evaluation. Space may be adjusted as needed. This evaluation is based on the following written observations and/or other data. This form is to be completed electronically. Lesson Objective (Educator created): Description: Element 1: The Learner: Effective Educators carry high expectations for their students and develop lessons that will engage and challenge their students. Their classrooms are places where positive interactions occur between Educator and student an...
Date Received. Notices shall be deemed effective upon the earlier of receipt, when delivered, or, if mailed, upon the date on the return receipt listed as delivered.
Date Received. Hearing Held? Yes No Date:
Date Received. This will be filled automatically with the date that you submit your application; leave blank.
Date Received. In accordance with OAR 000-000-0000 and your fully executed performance agreement, an applicant of an energy conservation project with certified cost of $1 million or more must recertify the tax credit annually up to three years following the date of the issuance of the final certificate to receive the full value of the credit. To recertify the tax credit, ODOE must receive an Application for Recertification at least 60 days prior to the anniversary date of the issuance of the final certificate.
Date Received. 1. Statement Of Grievance and the facts giving rise to the complaint:
2. The Section or Sections of the Agreement in dispute.
3. Relief Sought. Signature Date B. Date Received By Immediate Supervisor or Designated Representative: .
Date Received. Issued # Received Issued Losses / Adjustments Stock on Hand Remarks
Date Received. It is the Customer's responsibility to notify MGUC in writing if the term specified here changes.
Date Received. Processed By: Payment Method: Check (payable to Village of XxXxxxxx) Cash