AUTHORIZATION FOR EDUCATIONAL RELEASE TIME
(Refer to BOR Policy 4:17)
Employee Name ___________________________________________________________________________
(Last) (First) (M)
Title ____________________________________________________________________________________
Social Security Number ___________________ Department ____________________________________
Class Information:
Year________ Semester (Circle the appropriate one): Fall Spring Summer
Course Name & Number ____________________________________________________________________
Credit Hours _____ Day(s) of Week __________________________ Class Time ___________________
Per Board of Regents Policy 4:17, I am requesting approval to take up to three clock hours per week
of classwork without being required to make up this time.
I certify that I am a full-time non-faculty employee and have been continuously employed by the state
of South Dakota for one year or more in a full-time position, that the class is offered only during my
normal working hours and is not offered on the internet.
I understand that for employees covered by the overtime provisions of the Fair Labor Standards Act,
all hours over the three-clock hours limitation must be made up. I also understand that the hours of
educational release time do not count as hours worked and will not be calculated toward overtime.
Employee Signature _____________________________________________ Date ___________
Approval:
Supervisors Signature ___________________________________________ Date ___________
Dean/Director Signature _________________________________________ Date ___________
Please forward signed form to Human Resources
