ABCDEFGHIJKLMNOPQRSTUVWXYZ
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 GADSDEN INDEPENDENT SCHOOL DISTRICT
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EMPLOYEE CONTRACTUAL SERVICE AGREEMENT
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WORKSITE
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I,
Claimant, do solemnly swear or affirm, that the below mentioned
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services to be rendered are true and correct and that no part thereof has been paid.
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Services to be Rendered Dates of Actual Services
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Individuals Task:Will attend and participate in Kagan Coopereative Learning Workshop and share what I learn with other teachers at my campus.April 22, 2023
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Deliverables:Implement strategies and structures learned during the Kagan Cooperative Learning Workshop in my classroom and share this information with others.April 22, 2023
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Measurement of Outcome:Observable implementation of the strategies and structures learned in my classroom to increase student engagement and support students with accelerated learning especiall ELs.April 22, 2023
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(Attach a second page if necessary)
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TO BE PAID BY TIME SHEET
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PAYMENT COMPUTATION:
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A.Hourly rate of $25.00
per hr. x number of hours
6.25$156.25
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B.
Lump Sum Payment
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**Total Employee Compensation Amount$156.25
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*Applicable taxes and employee contribution to benefits will be deducted from paycheck.
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DISTRICT'S ESTIMATED TOTAL COST (ONLY FOR EMPLOYER USE)
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Compensation Amount$156.25
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Employer Benefits Cost$46.60
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District's Estimated Total Cost$202.85
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APPLICABLE FRINGE BENEFITS (EMPLOYER COST)LINE ITEMS:
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ERA @ 17.15%$$26.8052111
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ERA - Retiree Health@2.00%$$3.1352112
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FICA Taxes @ 6.20%$$9.6952210
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Medicare @ 1.45%$$2.2752220
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Workers Comp @ 2.95%$$4.6152710
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Unemployment @ 0.07%$$0.1252500
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TOTAL29.82%$$46.60
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Claimant's SignatureLast 4 digits of SSNDate
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APPROVAL FOR PAYMENT:
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I certify that the services mentioned above have been performed as stated and any and all documentation required is
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attached. I am therefore requesting that payment be made at this time.
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Control Agent's Signature and TitleDate
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11000.1000.51300.4010.019xxx.1411.23.0000Bilingual Ed.GAC/Academic Services
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Line item for above payment computation:
Department
Location
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FINANCE APPROVAL:
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Finance ApprovalDate
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ECSARevised 07/2022
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