Reason for Request. Under no circumstances will teachers berequired 2 to provide the supervisor with the reason for the personal leave request.
Reason for Request. Employees are not required to provide the supervisor the
Reason for Request. □ The student’s financial, educational, safety, or health conditions would likely be improved. □ Attendance in the nonresident district is more accessible to the parent’s/guardian’s place of work or to the location of child care. There is a special hardship or detrimental condition. The purpose of the release is for enrollment in an online course or school program offered by an OSPI-approved provider. Parent/guardian is an employee with the requested school district. BEHAVIOR (attach sheet with explanation for any yes answers) Does the student have a record of conviction of crimes, violent or disruptive behavior or gang membership? □ Yes □ No Has this student been expelled or suspended for more than 10 consecutive days? □ Yes □ No Has the student repeatedly failed to comply with requirements for participation in an online school program, such as participating in weekly direct contact with the teacher or monthly progress evaluations? □ Yes □ No Has the student and/or parent had any formal meetings with school officials regarding school attendance issues in the past two years? □ Yes □ No Is this student under a court order to attend school or is a truancy petition in the process of being filed? □ Yes □ No EDUCATIONAL SERVICES REQUESTED Does this student qualify for Special Education services? (Must have an active IEP and a current evaluation) □ Yes □ No After completion of the placement test, does this student qualify for TBIP (Transitional Bilingual Instruction Program) services? □ Yes □ No Does this student qualify as Exited TBIP? (To qualify, the student was receiving TBIP services in the previous school year and/or current school year, and scored a Level 4 in the annual WELPA test in either the spring of those years.) □ Yes □ No COURSES REQUESTED (Include course or coursework description, credit, % of the day, etc.) Resident School Nonresident School Grades K-12 Skill Center Running Start Please see third page for important notices, acknowledgements, and signature. OFFICE USE ONLY: Primary district whom is responsible for annual assessments and the portion of FTE each district is to claim for the student. Primary District FTE %
Reason for Request. The Xxxxxx Unified School District Governing Board has established a priority list for the placement of students. Please mark any item that applies to your student (see attached AR 5117 for more information): NEW STUDENT INTERDISTRICT ATTENDANCE (XXX) REQUEST □ Parent/Legal Guardian of the student is Active Duty Military □ Parent/Legal Guardian of the student is an Employee of Xxxxxx USD □ Student requesting to attend the highest-grade level at their school (grades 6, 8 or 12) □ Sibling of a student currently attending a Xxxxxx USD school □ Other:
Reason for Request. Have you ever attempted any of these courses at Widener? If Yes, Semester/Year: Grade:
Reason for Request. An employee who meets the “hardship” definition will be guaranteed an interview for a Board-determined vacancy at any of the work locations that the employee has selected. Employee’s Signature Date DISTRIBUTION: Original to Non-Instructional Staffing Copy to Administrator (Optional) Copy to be retained by Employee Form #4075 NEW – Employee Relations APPENDIX H THE SCHOOL BOARD OF BROWARD COUNTY, FLORIDA NON-INSTRUCTIONAL STAFFING XXXXXXXX X. XXXXXXX, DIRECTOR Telephone: 000-000-0000 Facsimile: 000-000-0000 PERSONNEL DATA FORM Job Family: Name Personnel Number Current Job Title Current Pay Grade College Degree: Yes No Degree(s) & Major(s): Enclosed is a listing of all position titles in your job family that are equal to or lower than your current pay grade, and that are held by employees with less seniority than you, as well as all vacant positions in your job family. Job descriptions are online at: xxxx://xxx.xxxxxxx.x00.xx.xx/Compensation/JDPDF/jdsearch2.asp. Job descriptions include qualifications and performance responsibilities for each position. Throughout this process, “seniority “shall be based upon employee’s date of hire pursuant to Article 3 of the BTU-TSP Collective Bargaining Agreement. Pursuant to Article 14 of the BTU-TSP Collective Bargaining Agreement, “For any option, the laid-off employee must be qualified for the position and the position must be at an equivalent or lower pay grade.” Failure to select one of the following options will result in the District determining your placement.
Reason for Request. Explain the business need behind this request. Provide an organizational chart and any other supporting documentation which may be useful in the review of this request. What specific classification change is being requested? (Grade, Title, etc.)
Reason for Request. (Please INITIAL the reason that applies to you) Graduation Please attach supporting documentation (see reverse). Conditional releases may be given for these requests pending final verification. If the PCER is unable to verify these conditions, the request will be denied and you will remain financially liable for the entire license agreement term, including miscellaneous charges assessed by the PCER. These conditions do not guarantee a release from your license. Withdrawal Academic Internship or University Approved Study Abroad program Military Duty Activation Other (See reverse side for reasons and selection) Please attach required documentation (see reverse). Requests that do not meet the options listed above will be considered and decided upon by the review committee. You will remain financially liable for the entire term, including miscellaneous charges assessed by the PCER.
Reason for Request. Explain the purpose for the access. Please note if a Master Key is being requested.
Reason for Request. ☐ Childcare ☐ Parent Employment ☐ Other (Explain below) Please explain the reason for your request. Include as much information as possible to help districts make an informed decision. Use additional pages as needed. If reason is parent employment or childcare, provide name, address, and phone number of childcare or work.
