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DOE OHR 200-012 STIPEND PROGRAM TEACHER SIGN-IN SHEET Last Revised 05/23/2013 Former DOE Form s N/A DEPARTMENT OF EDUCATION Office of Human Resources Reclassification Unit P. O. Box 2360 Honolulu HI 96804 Title of Training Activity Location of Training Activity Date s of Training Activity Training Sponsor Name Title Length of Training Activity 1/4 Day 1 Day Object Code 2802 Please Read This Stipend Program compensates certificated teachers and 10 month Educational Officers for attending voluntary training activities related to School and Complex/State goals and direction during non-work hours. Participants who receive stipends must attend the entire training activity there is no partial payments for attending part of a training. Payment of stipends is not allowed to non-certificated employees. My signature below indicates that I have read understand and am in agreement with the above statements. Name of Teacher Please Print DOE Employee ID number School or Office Today s Date Signature Distribution 1. Original -Sponsor 2. Copy 1- Complex Area Superintendent Office 3. Copy 2- School of Participants to be paid Page 1 of 1. O. Box 2360 Honolulu HI 96804 Title of Training Activity Location of Training Activity Date s of Training Activity Training Sponsor Name Title Length of Training Activity 1/4 Day 1 Day Object Code 2802 Please Read This Stipend Program compensates certificated teachers and 10 month Educational Officers for attending voluntary training activities related to School and Complex/State goals and direction during non-work hours. Participants who receive stipends must attend the entire training activity there is no partial payments for attending part of a training. Participants who receive stipends must attend the entire training activity there is no partial payments for attending part of a training. Payment of stipends is not allowed to non-certificated employees. My signature below indicates that I have read understand and am in agreement with the above statements. Payment of stipends is not allowed to non-certificated employees. My signature below indicates that I have read understand and am in agreement with the above statements. Name of Teacher Please Print DOE Employee ID number School or Office Today s Date Signature Distribution 1. Name of Teacher Please Print DOE Employee ID number School or Office Today s Date Signature Distribution 1. Original -Sponsor 2. Copy 1- Complex Area Superintendent Office 3. Copy 2- School of Participants to be paid Page 1 of 1. O. Box 2360 Honolulu HI 96804 Title of Training Activity Location of Training Activity Date s of Training Activity Training Sponsor Name Title Length of Training Activity 1/4 Day 1 Day Object Code 2802 Please Read This Stipend Program compensates certificated teachers and 10 month Educational Officers for attending voluntary training activities related to School and Complex/State goals and direction during non-work hours. Participants who receive stipends must attend the entire training activity there is no partial payments for attending part of a training. Payment of stipends is not allowed to non-certificated employees. My signature below indicates that I have read understand and am in agreement with the above statements.

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