EXHIBIT to Board Policy GBA - (1) Exhibit

           Exhibit GBA (1): Professional Personnel Compensation Guides and Contracts                 Status:

                                                Supplement Request Form
                                                     Division of Human Resources
                                                          Supplement Criteria
•     Can be a special project assignment, or a district initiative and should align to the District’s Strategic Plan
•     Newly assigned task requiring additional time and accountability above and beyond the existing job duties of the employee
•     Supplement can be implemented when all or part of an employee’s duties are being assigned to and executed by another
•     Supplement must be applied for on an annual basis
•     An assignment justifying supplemental pay should not exceed six (6) months and should not exceed ten percent (10%) of
      the employee’s salary.
•     Employee cannot receive more than 3 supplements per contract period (July 1- June 30 of each year)
•     Supplements must comply with all applicable BOE policies including GAAA.

                   REQUESTOR                                                             EMPLOYEE


NAME (Last, First, MI)                                                NAME (Last, First, MI)




POSITION TITLE (Superintendent or Division Chief)                     POSITION TITLE



REQUESTED SUPPLEMENT AMOUNT                                           REQUESTED EFFECTIVE DATE

SCOPE OF WORK
    Please explain why the work falls outside of or is in addition to the employee’s current responsibilities:




    Does the scope of work align with DCSD Strategic Plan? If so, please indicate the goal area:




    Please List any Key Artifacts (if applicable):


    Budget Charge Code:
    __________________________________________________________________________________________________
    _______
    Signature:                                            Date:


Supt./Designee:        APPROVED        DENIAL                        DATE