______________ Community College
AFT Teaching Faculty: Request for $500 Stipend
Name of Faculty Member:
Subject / Course No.:
Course Title:
Miles from College:
I certify that I am teaching one or more course sections, or have one or more clinical assignments, at a
location more than 10 miles from the college and am eligible for payment of the $500 stipend specified in
section 8.3.4 of the collective bargaining agreement between the Federation and the Board of Trustees of
Community-Technical Colleges.
Requested by / Date:
Signature of Faculty Member / Date
Approved by / Date:
Signature of Academic Dean / Date
Note: Payment should be made as a lump sum payment at the end of the semester.
For Payroll Use Only:
Date of paycheck in which
payment was made: