Date Received: Date of Last Column Change:
Date Approved: Initials of School Official:
Pay Date Effective: Column Change Approved:
(DO NOT WRITE ABOVE THIS LINE)
REQUEST FOR SALARY SCHEDULE COLUMN CHANGE
Building & Phone Ext. Grade / Subject:
Social Security #: Current Column:
Employee Signature: Year Started in District
GRADUATE COURSES - (Begin with most recent)
Semester & Year Course Title
College or University Taken Course Number
(Please use the date Hours/Credits
on the Transcript)
Bachelors Degree Awarded: Masters Degree Awarded:
DISTRICT IN-SERVICE HOURS
(All to be pre-approved; begin with most recent)
Date Number of
Sponsoring Agency Course Name Completed In-Service HOURS Instructor
Total: (be sure to include transcripts & signed approval forms)
1. Complete all sections.
2. Attach copies of relevant transcripts to request form. (Please note grade reports
are not acceptable.) Transcripts must denote graduate credits.
3. Attach copies of completion forms for district in-service hours.
4. Attach copies of signed pre-approval forms for graduate classes, along with
completion forms for any other in-service hours.
Only graduate credits from colleges and universities with accredited graduate programs
are acceptable or graduate credits from institutions that are affiliated with accredited
graduate schools. Currently not approved are: Chapman University/College, Leslie
College, McPherson College, Viterbo College, University of Phoenix, St. Mary’s
University, Fresno Pacific University, Walden University, University of St.
Thomas/IGS, University of LaVerne (this is not an all inclusive list). It is your
responsibility to check with the college or university to make sure of the above.
Viterbo College – not approved for Master’s Degrees. Courses approved for district
inservice hours only for teachers moving from Masters’ (MA) column to Masters+15
(MA+15) or Masters+15 to Masters+30 (MA+30).
Effective 1st Semester 2006-07: Marian College EDU-604 courses in their
recertification/professional development department will be accepted for district
inservice hours only.
See Appendix A of the Master Agreement for additional information.