Supplemental Pay/Adjustments
Please fill out each box to ensure correct payment.
Name
*
First Name
Last Name
Email
*
example@springtownisd.net
Department/Organization
*
Please Select
UIL
TMSCA
Before/After School Tutoring(SMS/SIS ONLY)
After School Detention
Saturday School
PACE LAB
Tutorials
Curriculum & Instruction
Select Option Below:
*
Please Select
Professional
Paraprofessional
School/Association
*
Please Select
GCES
Reno
SES
SIS
SMS
SHS
Safety
Admin
Budget Code
*
Date
*
-
Month
-
Day
Year
Date
Hours/Days
*
Date
-
Month
-
Day
Year
Date
Hours/Days
Date
-
Month
-
Day
Year
Date
Hours/Days
Date
-
Month
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Day
Year
Date
Hours/Days
Date
-
Month
-
Day
Year
Date
Hours/Days
Date
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Month
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Day
Year
Date
Hours/Days
Date
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Month
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Year
Date
Hours/Days
Date
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Hours/Days
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Month
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Hours/Days
__________________________________________________________________________________
TOTAL HOURS/DAYS
*
Input: Rate of Hourly/Daily Pay
*
TOTAL HOURLY/DAILY PAY:
*
REASON FOR SUPPLEMENTAL PAY/DUTIES PERFORMED:
*
Date Submitted
*
-
Month
-
Day
Year
Date
Employee Signature
*
Submit
Should be Empty: