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Partnerships2019 20 Step2 (Butte College)

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Rev (7/10/19)
Butte College Professional Development 2019 - 2020
Partnership Program Step 2 – Tracking the Partnership
Each partner must fill out a separate form as the partnership progresses. See info page.
Your Name: _________________________ Dept/Workplace: ____________________ Phone: _________________
ID#: _______________________ ❏Full-time Faculty ❏ Associate Faculty ❏ Classified Staff ❏ Management
Partnership was for: ❏Fall ❏ Spring Academic Year 20____
Partner Names: ___________________________________________________________________________________
Please maintain a record of contacts made during the partnership.
**Minimum of three sessions required. **Minimum of three hours total required.
Date
Nature and content of visit (attach pages if needed)
Time Spent
Overall evaluation of the experience: ________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Recommendations for future action: _________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________ Date ___/___/______
Your Signature
Check One:
❏ For Flex Hours ❏ For $65* ❏ N/A
Deliver completed forms to the Professional Development Office. Payments* to associate/non-teaching
faculty, classified and management staff are made at the end of the semester only.
For Professional Development Office Use Only
Budget Code ____11.000.400.1.675000.51490_________________
____________________________________________ Date ___/___/______
Approved by Professional Development Coordinator
Date recorded to instructor’s file ___/___/______
*The $65 stipend for Associate/Non-Teaching Faculty, Classified and Management is paid only if funds are
available. Confirm stipend funding with the Professional Development Office before choosing this option.
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Partnerships2019 20 Step2 (Butte College)

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Completed 22 July 2020

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