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St. Lawrence Valley Teachers’ Learning Center 106 Satterlee Hall – SUNY, 44 Pierrepont Avenue, Potsdam, New York 13676 TEACHER VISITATION APPLICATION FORM 1. The Teacher Visitation program is intended to promote professional sharing when that sharing is not possible through district resources. The Teacher Visitation program is not intended to supplant or duplicate district funds for the same purpose nor is it intended for conference attendance. 2. Following approval, a Certification form will need to be completed by the Superintendent as well as an Evaluation form by the teacher(s) involved. Participant(s) Name(s): __________________________________________________________ Subject and/or Grade Level: ______________________________________________________ District Name: ________________________________________________________________ Street or PO Box: ______________________________________________________________ Town and Zip Code: ____________________________________________________________ Location to be visited: ___________________________________________________________ Date (s) of visit: ________________________________________________________________ Reason or Purpose for Teacher Visitation: ___________________________________________ ESTIMATED EXPENSES ONE CHECK WILL BE ISSUED TO THE SCHOOL DISTRICT COVERING SUBSTITUTE COSTS AND MILEAGE. You will need to recover your mileage from your district. Substitute Teacher Cost ($60 max. per), ______whole day(s) ______ ˝ day(s) = __________ Mileage: __________ total miles @ $.445 mile (max of 200 miles) = __________ TOTAL COST: $ __________ Signature of Chief School Officer signifies his/her approval of the above request.
___________________________________________________________ _____________ Chief School Officer’s Signature Date |
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