Houston Independent School District 2012-2013
Stipend Creation Form – Stipend amount does not exceed $500
(Note: All created stipends must be approved by the Stipend Review Committee before the stipend duties begin
or employee is informed of stipend potential.)
▪ This form covers stipends that do not appear in the Compensation Manual.
▪ These stipends must not duplicate or supplement the annualized amount of existing stipends.
▪ These stipends must adhere to Compensation Policies and be reviewed by the Compensation Committee.
▪ Stipend owner must complete and submit the Tier Assignment form if the annualized stipend amount is greater than $500.
▪ Stipends not approved prior to start of stipend activity will require approval of CSO or Dept Chief.
▪ Co-Curricular stipends require up-to-date First Aid and/or CPR/AED certification/training.
Employee Name: EE ID #
School/ Department Name:
Tier 1 2 3 4
Employee Job Title:
Assignment Circle One
This Agreement is entered into by the Houston Independent School District, (HISD) and the HISD employee (Stipend Recipient).
1. HISD and the Stipend Recipient agree that the Stipend Recipient in addition to the duties of her/his regular HISD assigned position will carry
out the required duties, under the authority of the HISD Board and supervision of the Principal/Program Administrator of this stipend
2. The Stipend Recipient will successfully complete any training required by the Principal/Program Administrator to perform the stipend duties.
3. The Stipend Recipient agrees to act in accordance with all applicable laws and regulations, as well as the following conditions:
4. AGREEMENT TERM (dates): Begins: Ends:
5. RECOMMENDED ANNUALIZED $
PAYMENT (Entire Stipend Amount):
6. STIPEND PAYMENT FREQUENCY: ONE TIME – School year end or project BIANNUAL – 1/2 in December
Circle one completion and 1/2 in May
7. This agreement may be terminated by either party with or without cause by providing written notice to the other party. Further, the Stipend
Recipient may be removed from their stipend duties at the discretion of the principal or designee prior to the actual termination of this
agreement. Termination of this agreement by either party shall not, in itself, constitute cause for termination of any separate teaching or
employment contract between the Stipend Recipient and HISD.
This agreement and additional documentation required by law, regulations or policy must be signed by both the Stipend Recipient and
Principal/Program Administrator prior to the beginning of the stipend assignment.
STIPEND PAYMENT REQUESTED FOR THIS CURRENT PAY PERIOD
(½ of Annualized Payment if Biannual or
Annualized Payment if at project or year end)
$ MUST BE COMPLETED
Note: Biannual stipends require a Stipend Request form to be completed to receive the 2 payment.
Biannual combined stipend amount (Part I & II) can not exceed the annualized payment stated above.
BUS. AREA FUNCTION OBJECT ORG.# IA PROJECT FUND
Principal/Originator signature Date Chief School Officers signature Date
(If stipend amount is $7,000 or greater or if not approved before the
beginning of stipend program.)
If First Aid and/or CPR/AED Certification/Training is required for this stipend,
(Principal/Originator - Please print your name)
please initial below to verify that the certification/training is current:
Stipend Recipient _______________________
Sydne Marshall _________________________
Stipend Recipient Date
(Sign after the stipend has been approved. Keep the signed copy in Distribution:
school files) If stipend requires Certification/Training, mail or fax form to
Sydne Marshall. Fax 713-556-6912 or Mail Route 1
If stipend does not require Certification/Training, mail or fax form to
Compensation Dept. Fax 713/556-7384 or Mail Route 1