4-PCSD- Forms Examples.pdf

PARK CITY SCHOOL DISTRICT OVERNIGHT

PROFESSIONAL DEVELOPMENT TRAVEL CHECKLIST

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This form must be completed and submitted with ANY conference/travel request. Incomplete forms will not be accepted and may delay travel arrangements. Initial the applicable item:

I understand no expense can be processed including P-Card purchases without the proper conference/travel approval.

I have read and understand district Policy 4010 Professional Development Travel and Conference 5eTuest.

I have provided the appropriate account code information and funding sources.

I understand that all travel arrangements including, hotel, airline, and car rental if applicable, shall be made 30 days in advance of departure.

I have attached a hard copy of the Professional Development Agenda. WKH 3URIHVVLRQDO 'HYHORSPHQWJHQGD

I understand that if I change or cancel my travel arrangements, I may be responsible to pay the district any expenses that were incurred on my behalf.

I have obtained my Supervisors signature and completed the request form.

I understand that by signing this document, I agree with all of the above items.XQGHUVWDQG , DP UHTXLUHG WR WXUQ LQ D FRS\ RI DOO UHFHLSWV ZLWK P\ 3URIHVVLRQDO 'HYHORSPHQW WUDYHO IRUP UHJDUGOHVV LI WKH DPRXQW LV

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Signature: Date: ___________________

PROFESSIONAL DEVELOPMENT TRAVEL REQUEST

Refer to Board Policy 4010

CONFERENCE NAME CITY, STATE

NAME POSITION SCHOOL LOCATION

*Conference Dates: Begin Date _________Time ________End Date__________Time_______

SPECIFY HOTEL

1ST CHOICE: 2ND CHOICE:

PHONE NUMBER: _______________________________________ PHONE NUMBER: __________________________________________

CAR RENTAL NEEDED: YES __________ NO _______

Car rentals may be allowed if transportation is not provided between hotel and conference location and must be preapproved t hrough the Superintendent or designee.

Estimated Costs Actual Costs (to Ee completed after trip))

Registration $ Registration $

Airfare $ Airfare $

Baggage Fees

Baggage/Other Expenses

Lodging (__________# of nights) $ Lodging (__________# of nights) $ Meal Per Diem $ Meal Per Diem $

Car Rental (must be pre-approved)

Car Rental (must be pre-approved)

Parking Fees $ Parking Fees $ Transportation (Uber/Lyft/Taxi)

Transportation (Uber/Lyft/Taxi)

Sub Costs ( _________# days) $ Sub Costs ( _________# days) $

TOTAL $ TOTAL $

REQUIRED INFORMATION FOR AIR TRAVEL

Name (as it appears on driver’s license): ___________________________________________

Date of Birth: ___________________________________________

Cell Phone Number: ___________________________________________

Preferred Departure: Date ________ Time _______ Return: Date _______Time __________

FOR OFFICE USE ONLY

DATE RECEIVED:

PCSD A ACCOUNT #: ____________________________ SUPERVISOR/PRINCIPAL: __________________________________________________________

SIGNATURE DATE

FUNDING SUPERVISOR APPROVAL ____________________________________________________________________________________

SIGNATURE DATE

BUSINESS ADMINISTRATOR APPROVAL ___________________________________________________________________BBBBB_____

SIGNATURE DATE

SUPERINTENDENT APPROVAL: ________________________________________________________________________________

Travel checklist must be submitted with travel request. Revised �8���

Please complete the following. The District Office can assist all travel arrangements. If there are special circumstances, please attach a note specifying your exact needs. A COPY OF THE PROFESSIONAL DEVELOP0EN7 AGEN'A MUST

BE ATTACHED TO THE REQUEST.

PURPOSE OF THE

TRIP:__________________________________________________________________________

How many times have you traveled out of state this school year?

lpearce@Pcschools.us Highlight lpearce@Pcschools.us Highlight

Employee Name: _____________________________________________ Today’s Date: ____________

Does Employee have assignments at two locations? YES NO

Position Location 1: ___________________ Location 1: _______________ Location 1 FTE: ____

Position Location 2: ___________________ Location 2: _______________Location 2 FTE: _____

EFFECTIVE DATE OF CHANGES: ____________________________

Location 1: Location 2:

FTE Change Increase Decrease FTE Change Increase Decrease

New FTE/Hours: _______________ New FTE/Hours: _____________

Is this a Position Transfer?

No Yes New Position Title: ___________________________________ New FTE/Hours: ______

New Location: _______________ Person being replaced: ___________________________________________

Justifications of transfer or change in position:

The employee has been notified of this change: No Yes

Funding Source: ________________________________________________________________

Date

Date

Date

Date

Administrator Approval

Business Department Approval

Teaching and Learning Approval

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SPECIAL ASSIGNMENT/EXTRA-DUTY CONTRACT

This Special Assignment Contract is hereby entered between the Board of Education of Park City School District, (the “Board”), and the employee named herein, (“Employee”). The parties hereby agree that in exchange for the mutual consideration set forth below and subject to the terms set forth herein, the employee will perform the special assignment described.

Any work performed prior to special assignment contract approval is not authorized and will not be compensated. Compensation rate is subject to verification and is intended to conform to the rate agreed upon in the Licensed Professional Agreement or other negotiated agreement between the Board and its employees. Employee agrees that in the event of an error in the stated rate, the rate may be adjusted to conform to the LPA or other negotiated agreement.

The employee agrees to complete all assigned duties, to maintain high professional standards, to serve as a suitable role model for students, and to adhere to school and Board policies in performing the requirements of this Special Assignment Contract. If this Special Assignment Contract is for any activity governed by the Utah High School Activities Association (UHSAA), then the employee also agrees to abide by all of the UHSAA’s rules and regulations.

The parties agree that this contract is completely separate and distinguishable from any other contract of employment between them, whether oral or written. The parties each agree that Employee does not have an expectation of continued employment under this Special Assignment Contract. The assignment is at the will of the Park City School District and this Special Assignment Contract can be terminated at any time during the anticipated duration of the assignment, with or without cause.

Employee agrees that if the assignment is terminated or if employee is not offered a subsequent special assignment contract after the anticipated period of this Special Assignment Contract, such action does not constitute a termination of employment and Employee will not be entitled to grieve such action or otherwise contest the action through use of the Board’s orderly termination policies and procedures. (See Board Policy 7040 and 7060.)

PROGRAM ADMINSTRATOR USE ONLY:

Total Program Funds Available: (Total funds available must cover FICA, URS, etc if applicable)

Payment Schedule: Number of Payments: Account Number:

Site/Program Administrator Date

Employee Signature Date

Superintendent Date

Business Administrator Date

Human Resources Date

Assignment Start Date: __________________________________ Assignment End Date: _________________________

Employee Name: _______________________________________ Location: ___________________________________

Current Position: ________________________________________ Current FTE: ________________________________

How Many Special Assignment Contracts does employee currently have in place for current school year? _____________

Special Assignment Start Time: ____________________________ Special Assignment End Time: __________________

Special Assignment Title: _______________________________________________________________________________________

Details of Responsibilities outside of the scope of regular assignment:

Contract Compensation: ________________________________ Compensation Type: _________________________

EXTRA-DUTY ASSIGNMENTS

I. Guidelines

1. In order to be offered an extra duty assignment, an individual must be officially employed by PCSD, having gone through the hiring process including, but not limited to, background check and payroll information.

2. Prior to starting any extra duty assignment work, employee must have a special assignment contract issued and signed by building administrator AND approved at the district level.

3. Any work performed prior to special assignment contract approval is not authorized and will not be compensated

4. All payments under special assignment contracts must be processed through the PCSD payroll system

5. The district may limit the number of extra duty assignments authorized for any given fiscal year

6. The district may limit the number of extra duty assignments authorized for any given employee

7. All extra duty assignments must have a special assignment contract regardless of funding source

8. The district reserves total discretion to grant or deny approval of extra duty assignments and can terminate the special assignment contract at any time with or without cause

ARTICLE V - SALARY PROCEDURES

Licensed Professional Agreement

5.12. PAY FOR DISTRICT STAFF TRAINING AND CURRICULUM DEVELOPMENT AND EXTRA DUTY PAY: Stipends may be available for special projects based on the nature of special contract activities. Considerations include but may not be limited to:

5.12.1. In general, activities that do not require preparation from teachers will be compensated at the BS-1 rate. When the primary duties are: providing supervision, support and availability that is accessed randomly by students, BS-1 rate applies. Activities that require teacher preparation, expertise and specially-designed (specialized) instruction to improve academic performance tied to a specific outcome, teachers will be compensated at the daily rate.

(a) Teaching preparatory classes in licensed/endorsed subjects (outside of contract and/or during the summer): Hourly Rate

(b) Loss of Prep: Hourly Rate

(c) Summer school: Hourly Rate

(d) Homebound/Hospital instruction: Hourly Rate

(e) After-school homework clubs: BS-1 Hourly Rate

(f) Curriculum Mapping: BS-1 Hourly Rate

(g) Reader/Grader: BS-1 Hourly Rate

(h) Conference/Training attendance initiated/requested/required by the district (determining factors include is the activity initiated as an option, requested or required by the district, the activity is considered contract work or not, and/or during the contract year vs. during the summer, is district paying for flights, ground transportation, hotel, per-diem, conference registration, etc.):

• District requested/required attendance: Hourly Rate

• Teacher requested/approved: BS-1 Hourly Rate

• Optional attendance: BS-1 Hourly Rate

(i) District sponsored summer professional development (determining factors include is the activity initiated as an option, requested or required by the district):

• District requested/required attendance: Hourly Rate

• Teacher requested/approved: BS-1 Hourly Rate

• Optional attendance: BS-1 Hourly Rate

(j) Conference attendance initiated/requested by the employee: No Additional Compensation

(k) Extracurricular activities (i.e. chaperoning, ticket sales/collection, scorekeeping, announcing, etc.): $25

Replacement of Current Position (Replacing Who? ) Current FTE:

Request for Posting of Position

Office Use Only: Job Req #

Requested By: Today’s Date: Location:

Title of Position to be Posted: Contract Days:

Licensed Position Classified Position Administrative Position Contracted Position

Normal Posting Period Open Until Filled Internal Posting Only

Special instructions or requirements for this position:

Are you requesting an FTE increase or decrease to this position? No Yes New FTE or Hrs per week

New Position Full Time (1.0 FTE 40 hrs/week) Part Time – FTE or Hrs per week:

Funding Source:

Ongoing M&O Title I PCEF

Special Ed Title II Other:

Land Trust Title III (ESL)

Human Resources Approval:

Date

Randy Upton, Business Administrator Date Teaching And Learning - Amy Jenkins Date

Student Services - Dr. Carolyn Synan Date Todd Klarich, Director Community Ed Date

Lyndsay Huntsman, Superintendent Date Other Program Director (Program Source) Date

Todd Hansen, Bldg and Grounds Date

Position Lane: Salary Range: Account Code:

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