Request for ADG Assignment

Part I: Requester (Supervisor/Chair etc) complete the following:

  1. Assignment requested for

Name / Employee # / Start Date / End Date

Regular FacultyAdjunct Faculty

  1. Check off type of ADG

ADG Area (Check One) / Requirements for Eligibility and Payment / Compensation Range
(Final Determination enter in box)
Course Revisions/Updating (Existing Course)
New Course (Course Outline Only) /
  1. Copy of Curriculum Committee Agenda
  1. Hard Copy of course outline with complete signature page
  1. Electronic version of course outline
/ $500-$1,000 Depending on scope of class and curriculum status (New, Revised Course, Archived)
For Administration Use:
Amount $
Online Course Development (Moodle Shell, Content, Exercises, Tests, etc.) - /
  1. LATTC Distance Ed Instructor Approval
  2. Moodle shell(s) created, content for entire semester loaded including
  • course information,
  • assignments,
  • exercises,
  • examples,
  • quizzes/tests, etc.
  1. Complete Moodle course electronically delivered to Distance Education Coordinator and area Vice President
/ $1-2,000 Depending on scope of class
For Administration Use:
Amount $
New Certificate/Degree Application Package - /
  1. Completed California Community Colleges Application for Approval (CCC-501) approved by the LATTC Curriculum
  2. Four copies of CCC-501 with original signatures
  3. LOWDL Program Approval
/ $2,500 to $4,000 Depending on intensity of program, type, etc.
For Administration Use:
Amount $
New Course Package* (Course Outline, Sample Syllabus, and Sample Instructor/Student Resource Documents) / Specify: / $1,000-$2,000 Depending on scope of class
For Administration Use:
Amount $
Other – Describe: / Specify: / For Administration Use:
Amount $ 1000.00

B. Courses and Program Certificate Development

Type:
-New Course
-Course Update
-New Program / Subject / Number (if known) / Title / Date to be Presented at Curriculum Committee / Amount Requested / Admin Use Only

Part II: ADG Assignment Recommended For:

Qualifications of the Candidate: Summarize candidate’s educational preparation and work experience related to the proposed project that meet minimum qualifications and attach resume providing further information.

Education:
Experience:

Part III: Acknowledgement

Pursuant to Article 41 (Intellectual Property) of the AFT Agreement, I understand that Los Angeles Trade Technical College retains all ownership rights to all materials developed and compensated through this assignment.

I understand this assignment is for compensation for work that is beyond the scope of regularly assigned duties outlined in Article 13 (Assignment) of the AFT Agreement including teaching, office hours, student consultations by appointment, and other college activities such as evaluation of student performance, curriculum development, sponsorship of co-curricular groups, college of District committee work, faculty meetings, or in-service training or staff development. As such this assignment must be completed during non-duty hours (e.g. outside the hours assigned/compensated for conducting the activities listed above).

I understand the terms specified above of this ADG assignment including the end date of the assignment. Work performed beyond this assignment date will not be compensated.

______

Name of Faculty/ADG Signature of Faculty Member/ADGDate

I agree to supervise the work and review the final product prior to final request for payment.

______

Name of Supervisor/Chair Signature Date

Approved Not Approved (Reason):

______

VP of Workforce and Economic DevelopmentDate

Copy to Requester and ADG Candidate

Part IV: FOR DIVISION USE ONLY

  1. Assignment
  1. Copy to Requester Sent: _____/____/_____ by ______
  2. Copy to ADG Candidate Sent: _____/____/_____ by ______
  3. Funding Source: Acct/WBS: ______G/L 239300
  4. Date ADG HR 350 Form Submitted to District: _____/____/_____ by ______
  5. PCR Entered: _____/____/_____ by ______
  1. Project Completion
  • Documentation Check (Audit Files)
  • Copy of Signed Documents with all Original Signatures (If Applicable)
  • Electronic Copy of Document(s)
  • Other:______
  1. Payment and Follow-Up
  • Sent to Request for Payment on _____/____/_____ by ______
  • Paid on _____/____/_____ checked by ______Date:

Comments/Notes: