Class Splitting Voucher

Stamford Public Schools | Stamford, Connecticut

Authorization for Payment for Class Splitting

Clock

Teacher Submitting for Payment Name (Last name A-L) *

Teacher Submitting for Payment Name (Last name M-Z) *

School Email for Notifications*

School Name*

Check One *

Half Day (3 Hours) Full Day ( > 3 Hours)

Date Class Split Occurred*

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Option1

Teacher whose class you covered*

First Name

Last Name

Time From*

Time To*

Signature of Claimant*

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Date

: :

All Information above is correct *

Yes No - Please provide explanation in space provided

Denial Explanation

Who is completing this verification? *

Office Support Staff Principal/Administrator

Select Principal from list below *

Signature of Principal Authorizing and Confirming Class Splitting

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Date/Time

Signature of Principal Authorizing Class Splitting

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Date