Please complete this form AND submit official supporting documentation to the ECKCE office by September 10, 2011 if you plan to move over on salary schedule during the 2011-2012 school year. (Official supporting documentation would include either your College or IDP transcripts.)

Name: *

Date: *

Year20112012201320142015

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

School Assigned: *

My current degree and hours (i.e. BS + 8): *

My new degree and/or hours (i.e. BS + 16): *