BLUE Change Request
Type of Request:
I am on the BLUE contract and would like to move to a regular contract.
I am on a regular contract and would like to move to the BLUE contract.
Immediately (Day Submitted)
End of Semester
End of Year
Email Address for your Principal (This must be exactly correct so that they will receive notification of this request.):
Employee First Name:
Employee Last Name:
Employee ID Number:
Please select correct grade level you currently teach.
CHRIST THE KING
DM ALT CENTER
EA CHILD PROGRAMS
FOCUS @ HOYT
HH @ BLANK
HH @ LUTHERAN
HH @ MERCY
MC COMBS MS
MC KEE EDUC CTR
MS ALT CTR TAY
RUBY VAN METER
Your Email Address:
Date of hire (mm/yyyy):
Reason(s) for request to move from a BLUE to a regular contract:
Reason(s) for request to move to a BLUE from a regular contract:
Please list the individual(s) you have met with regarding your concern(s) and request.
Jeremy Schwennen - Mentoring and Induction Coach
Other (Please list)
Other (Please list)
I understand that between years one and prior to the start of the second semester of year four, I can withdrawal from the BLUE contract without any financial responsibilities associated with the Master’s program of study.
I understand that between year four, second semester and year eight of the BLUE contract, that my request to withdrawal from the BLUE contract will have financial responsibilities associated with repayment of the Master’s program of study.
Electronic Signature: Please type your First and Last Name (By signing electronically, you have agreed to conduct this transaction by electronic means, and further agree your electronic signature is the legal equivalent of your manual signature. You also agree that no third-party verification is necessary to validate your electronic signature.)
Electronic Signature: I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the information above.