Stipend Request form - My Tri-C Space - Cuyahoga Community College by de443B3

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									                                       Adjunct Faculty Development Workshop

                                               STIPEND REQUEST FORM

Upon completion of four adjunct faculty development workshops, it is your responsibility to complete the enclosed form in
order to receive your $200 stipend. Please print and complete this form as soon as possible. A supplemental pay proffer
will be issued to you.

Mail to: Cuyahoga Community College
         Eastern Campus – Evening/Weekend Program
         Attn: Barb Pitrone or Monica Armour
         4250 Richmond Rd.
         Highland Hills, OH 44122

or Fax to : (216) 987-2161


Name:

Address:



Phone:                   (      )        -

Tri-C ID:                S

Home Campus:                 East      Metro      UTC        WEDD         West


I have participated in the four (4) faculty development workshops listed below: (You can access your course records
through My Tri-C Space. Then go to My Info Tab > Student Records > Review or Print Your Unofficial Educational Record
and/or InSight! > Learn > Learning Activity Reports > Training Transcript).


1.

2.

3.

4.


         _____________________________                           _____________
                  Signature                                          Date


We hope that you have enjoyed and benefited from the workshops. Additional workshops will be announced for the
upcoming semester. Thank you for your continued participation in this important area of professional development. If you
have questions or concerns regarding your stipend please contact Barb at 216-987-2335 or Monica at 216-987-2225.

								
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