Authorization Form
Emergency Class Coverage Program
Offi ce of the Chief Operating Offi cer
MONTGOMERY COUNTY PUBLIC SCHOOLS
Rockville, MD 20850
School Name School Number
Date Absent Teacher Substitute Calling System Number
MCPS Form 430-10, 5/05
Period Teacher Providing Coverage
Teacher Verifi cation That Coverage Was
During Planning Period (Signature)
1
Name
Employee ID #
2
Name
Employee ID #
3
Name
Employee ID #
4
Name
Employee ID #
5
Name
Employee ID #
6
Name
Employee ID #
7
Name
Employee ID #
8
Name
Employee ID #
Person Preparing Form Approved
Signature, Principal/Principal Designee
DISTRIBUTION: Form should be maintained with the school’s payroll records.