Adopted: 4-4-06

This application must be completed by the building principal or direct supervisor and submitted to the District by May 1 in order to be approved for the next calendar year.

The terms of this decision and/or agreement will be in accordance with the District’s “Extra-Period Policy.”


Principal/Supervisor: _________________________________      Date:  ___________


Name of Teacher: ____________________    Class to be offered: ________________


Length of Request:  Quarter: ____  Semester: ____  Full Year: ____


Describe why it is essential for this extra period to be taught and attach other documentation as needed:









Anticipated funding for extra period:

  1. District Funded: ____________             Amount: $ ___________
  2. Other Funds (specify): _____________   Amount: $ ___________
  3. Combination of District and Other Funds:
    District’s Share: $ _________________      Other Funds: $ ____________


Signature of Principal/Supervisor: ___________________________    Date: __________


Signature of Teacher: _____________________________________    Date: __________



(To be completed by District)

______________________________ has been (approved/denied) to teach an extra

period for the _________ school year.

If approved, the total amount to be paid to the teacher for this extra period is $_____________. This amount will be divided and paid equally through the 12 pay periods unless other arrangements are made.


District Signature: _____________________________            Date: _________________

Print Email