ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
PRAIRIE ROSE SCHOOL DIVISION
2
RECORD OF TEACHER EXTRA-CURRICULAR STUDENT RELATED ACTIVITIES
3
“Extra-Curricular activities” means student-related athletic, social, recreational, and cultural activities, occurring outside the normal school day, but does not include activities related to academic or instructional matters or curriculum subjects outside the normal school day, whether such occur alone, or with students, parents, or administrative staff, such as (without limitation) staff meetings, committee work, in-service sessions, marking and setting examinations, or marking school assignments.
4
A teacher who participates in extra-curricular activities shall be entitled to a paid leave of absence of one-half day for twenty-five (25) hours of extra-curricular activities to a maximum of four (4) half days. Hours not meeting the minimum requirement (of the first 25 hours) can be carried over to the next school year. This day must be requested in writing to the Superintendent for approval.
5
Date of ActivityDescriptionTime Spent (in hours)
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
Total 0
30
31
____________________________
________________________________
__________________________
32
Teacher's Name (please print)Teacher's SignatureDate
33
34
35
_______________________________________________________________
36
Principal's SignatureDate
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100