NORTH THURSTON PUBLIC SCHOOLS NO. 3

Human Resources Department

APPLICATION FOR SALARY CREDIT/CLOCK HOUR PRIOR APPROVAL

Instructions: Please complete form and submit to Human Resources for prior approval of salary credit or for clock hours taken outside of the North Thurston Public Schools. Attach literature/flyer explaining course offerings with this form.

Name:Location:

Date: Subject: SSN#

CRITERIA

In compliance with WAC 392-121-262, credits earned after September 1, 1995, will be counted towards salary increments only if the content of the course meets at least one of the following:

1.It is consistent with a school-based plan for mastery of student learning goals as referenced in RCW 28A.655.110, the annual school performance report, for the school in which the individualis assigned.

2.It pertains to the individual's current assignment or expected assignment for the following school year.

3.It is necessary for obtaining endorsement as prescribed by the State Board of Education.

4.It is specifically required for obtaining advanced levels of certification.

5.It is included in a college or university degree program that pertains to the individual's current assignment or potential future assignment as a certificated instructional staff of the school district where the potential of the future assignment is agreed upon by the school districtand the individual.

6. It addresses research-based assessment and instructional strategies for students with dyslexia, dysgraphia and language disabilities when addressing learning goal one under RCW 28a.150.210, as applicable and appropriate for individual certificated instructional staff.

7.Beginning in the 2011-2012 school year, it pertains to the revised teacher evaluation system under RCW 28A.405.100, including the professional development training provided in RCW 28A.405.106

□ CLOCK HOUR- Prior Approval:

You are required to complete an official SPI Clock Hour Verification Form and obtain the instructor's signature upon completion of the course. The original clock hour form must then be submitted to Human Resources.

Course Title:

Dates of Inservice:Sponsoring Agency:

Total Hours Available: Organization Responsible for Inservice:

Meets criteria # above. Explain:

Participant's Signature DateHuman Resources Signature Date

Office use only:□Clock Hours Approved*□Clock Hours Not Approved

□ COURSE CREDIT- Prior Approval:

Duplication of a previous course is not, in most circumstances, approved for salary advancement. Please contact Human Resources if you need clarification.

Course Title:Course #:College/University:

Dates of Course: # Credits: □Quarter □Semester

Meets criteria # above. Explain:

Participant's Signature DateHuman Resources Signature Date

Office use only:□Course Credit Approved*□Course Credit Not Approved

*Please note that approval has been granted, but an original clock hour verification form or official transcript must be received in Human Resources by September 30th to be granted credit towards salary advancement.

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