Name: __________________ Email: ____________________________ AreaĞĂŶ: ___________ͺͺͺͺ
Fill out the table below using the Academic Senate approved list of FLEX activities. Please be specific with the dates and times as activities may only
be performed during non-accountable hours. If you attended Convocation and/or FLEX workshops, we have records documenting your attendance so
no need to provide sign-in sheets in this case. For all other activities, you must provide supporting documentation or write a short description of how
the activity relates to instructional improvement, staff improvement, and/or student improvement. Please avoid acronyms when possible.
Merced College Full3DUW Time Faculty FLEX/Staff Development Form 2019-2020
FLEX plans are due by February 1, 2020 and all documentation must be submitted by May 1, 2020.
Activity #
Description of the Activity
Details of Senate approved activities
and sample documentation can be
found on pages 3-4
Exact Date(s)
Do not list a
range of dates
Exact Time
Total
Hours
(Example)
3. FLEX Workshop
Workshop#14 Knewton/Openstax
Aug. 9
2-3pm
1
Total FLEX Hours (This number should match your obligated hours shown on top.)
Please Select One:
Instructor
Instuctor PT
Counselor With Course Load
Librarian
Librarian With Course Load
Number of Instructional Units for 2019-2020:
FLEX Obligation:
hrs.
(Do not include overtime, reassigned time, or short-term courses)
1.Convocation
1.Convocation
1.Convocation
1.Convocation
1.Convocation
1.Convocation
1.Convocation
List additional activities:
0.00
Choose ONE Submission Option and SIGN Your Complete Name
Submission Option #1 My FLEX obligation has been meet and documentaion is attached.
Signature Faculty confirms their FELX obligation has been
fulfilled and all documentation is attached.
Date
Submission Option #2 My FLEX obligations is in progress according to the plan above.
Signature Faculty confirms they have a plan in place and will
complete their FLEX obligation and re-submit this form and all
documentation by May 18, 2020.
Date
Faculty Comments
ELECTRONIC SUBMISSION OF THIS FORM WILL BE USED AS MY SIGNATURE
By signing this form, I CERTIFY THAT NO SUBMITTED ACTIVITIES HAVE BEEN COMPENSATED OR
SUBMITTED FOR SALARY ADVANCEMENT
For Administrative Use Only Below This Line
Signature Dean confirms all FLEX obligations have been met
with activities that fall within the date and times specified by
the FLEX guidelines.
Date
Dean Comments
Signature FLEX Committee member conducting the Review
Date
Committee Member
Approves all FLEX
Activities
Committee
Member
Disapproves one or
more FLEX
Activities
Required
**
**
**
click to sign
signature
click to edit
Effective 2019-
Appendix A- Senate Approved FLEX Activities List
1. Convocation- Mandatory 6 hours FLEX day
Documentation: None. The FLEX Coordinator has the sign-in sheets documenting your attendance.
2. Teacher Learning Academy workshops (TLA)
Documentation: Sign-in sheet with printed names and signatures.
3. FLEX Workshops- Planned and scheduled by the FLEX Committee
Documentation: None. The FLEX Coordinator has the sign-in sheets documenting your attendance.
4. Adjunct orientation
Documentation: Sign-in sheet with printed names and signatures.
5. FOR ADJUNCT PROFESSORS ONLY Area meetings, Department meetings, Cohort meetings. For full time instructors
this is a professional responsibility as outlined by faculty agreement.
Documentation: Sign-in sheet with printed names and signatures.
6. Annual program review
Sample Documentation: Meetings sign-in sheets with printed names and signatures, front cover of finished product
with name of contributors.
7. Comprehensive program review
Sample Documentation: Meetings sign-in sheets with printed names, front cover of finished product with name of
contributors.
8. Faculty evaluations beyond contractual obligations
Sample Documentation: Copy of the first of page of the evaluation report.
9. Committee meetings/committee responsibilities
Sample Documentation: Copy of meeting minutes page containing the attendance for the meeting.
10. Student club advisors
Sample Documentation: Meetings or activities sign-in sheets with printed names and signatures or minutes.
11. SLO analysis meetings
Sample Documentation: Sign-in sheet with printed names and signatures.
12. Mentoring new faculty/interns
Sample Documentation: A log, journal or other document verifying dates, times, and an explanation of the activity.
13. Quarterly safety training (not completed in an area/cohort/department meeting)
Sample Documentation: Copy of completion sheet with printed names and signature.
14. Sexual harassment training
Documentation: Sign-in sheet with printed names and signatures.
Effective 2019-
15. Workshops/Conferences- Live or Pre-recorded
Live Workshops/Conferences Sample Documentation: A brochure or agenda, proof of attendance such as a receipt for
registration fees and an explanation of how it relates to improvement of professional effectiveness.
Pre-recorded workshops/conferences Sample Documentation:
If 3 or more faculty watch a pre-recorded workshop at the same time, a sign-in sheet will suffice as documentation.
If an individual faculty watches a pre-recorded workshop, a brief but detailed paragraph about the workshop and an
explanation of how it relates to improvement of professional effectivenes will suffice as documentation.
16. Continuing education (UNLESS taken at a college for salary advancement)
Sample Documentation: Course description, plus a transcript or official grade report and an explanation of how the
course relates to improvement of professional effectiveness
17. Modifying an existing course:
New text book (only during the first semester the instructor uses the new text)
New online component
Developing lab component or changing existing labs
Applying a theme to the course
Creating PowerPoint lectures
Creating a learning management shell for your course (on the condition that the instructor is not receiving
release time or stipend)
New to teaching a course or a significant amount of time has passed since course has been taught
Sample Documentation: Copy of course syllabus, log, journal or other document with an explanation of the activity,
product or outcome information.
18. Institutional research
Documentation: An explanation of the research problem undertaken, a summary of activities including dates and
times, and if applicable an annotated bibliography of all works researched.
19. Student outreach
Sample Documentation: A log, journal or other document verifying dates, times, and an explanation of the activity,
product or outcome information.
20. Writing grants
Sample Documentation: A log, journal or other document verifying dates, times, and an explanation of the activity,
product or outcome information.
21. Preparing a course to go through curriculum committee
Sample Documentation: Screen shot of course outline cover page containing the name of the originator.
22. Other (Note: Must document in advance)
Documentation: Fully documented by a log, journal or other document verifying dates, times, and an explanation of
the activity, product or outcome information and how it relates to improvement of professional effectiveness.
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome