South Western School District

SOUTH WESTERN SCHOOL DISTRICT

REQUEST FOR ADVANCED PLACEMENT ON SALARY SCHEDULE

To be used when coursework has been completed in a timely manner but delays in college or PA Department of Education processing will prevent receipt of official transcripts for coursework or receipt of the Instructional II or Mater’s Equivalency Certificate prior to timeline specified for pay adjustment.

Click to choose a placementInstructional IInstructional IIMaster's Degree (Courses DO NOT need to be listed for these upgrades.

Click to choose an upgrade levelM+15M+30M+45 (Courses MUST be listed for these upgrades)

I hereby certify that I have successfully completed and will receive a passing grade for the following courses:

On the basis of this information, I request adjustment to the appropriate salary level with full understanding and agreement that my salary will be reduced by the amount of increase if supporting official transcripts are not received by ______.

Master’s Equivalency Certificate

I hereby certify that I have successfully completed the required courses and have made application to the Pennsylvania Department of Education for a Master’s Equivalency Certificate. On the basis of this information, I request adjustment to the appropriate salary level with full understanding and agreement that my salary will be reduced by the amount of increase if the certificate should not be granted by ______.

______

Signature of Teacher Signature of Witness

______

Date Date