INSTRUCTIONS: Refer to reverse side of this form for complete instructions and additional information.
Select the salary lane for
which you are applying
Master’s Lanes OR Equivalent
o
M o MEQ
o
M+30 o MEQ+30
o
M+60 o MEQ+60
If you are on the MEQ lane and have received your
master’s degree, contact the Certification Unit for
instructions on how to update your degree.
Last Name _____________________________________Employee ID# ___ ___ ___ ___ ___ ___
First Name
_____________________________________ Middle___________________________
School/Office/Location
___________________________________________________________
Current Work Assignment _________________________________________________________
* Salary lane changes apply only to educators on the MCEA Unit A–D salary schedule and on
active or paid leave status.
COURSE INFORMATION
Check one:
o
My original official transcript is attached—photocopies and printed digital transcripts are NOT acceptable.
o
All of my original official transcripts have been previously submitted to the Certification Unit.
o I have requested original official transcript(s) to be sent to the Certification Unit from:
Name of College(s) _________________________________________________________________ Date Requested _____/_____/______
Name of College(s)
_________________________________________________________________ Date Requested _____/_____/______
Name of College(s)
_________________________________________________________________ Date Requested _____/_____/______
Course(s) (no more than 3 courses) that you have completed and believe qualifies you for salary advancement. This helps us
determine if we have your most recent coursework on file.
DEPARTMENT
AND COURSE #
FULL COURSE TITLE
SEMESTER
HOURS CREDIT
DATE
COMPLETED
COLLEGE OR UNIVERSITY
THIS REQUEST WILL NOT BE PROCESSED WITHOUT THE APPLICANT’S ORIGINAL SIGNATURE OR E-SIGNATURE AND DATE
I understand that my electronic submission of this form and my electronic signature are intended to be, constitute, and are equivalent to my personal signature.
Signature, Applicant ___________________________________________________________________________ Date _____/_____/______
FOR CERTIFICATION UNIT USE ONLY
ACTION:
Date all official documentation received _____/_____/______ Employee ID# ___ ___ ___ ___ ___ ___
COMMENTS:
o
Approved: Effective Date _____/_____/______ o Disapproved o
HRO Transaction Entered
I understand that my electronic submission of this form and my electronic signature are intended to be, constitute, and are equivalent to my personal signature.
Signature, Director/Designee, Certification Unit ___________________________________________________ Date _____/_____/______
DISTRIBUTION: Original to the Certification Unit; COPY/Returned to employee for confirmation
Request for Advanced Salary Placement
Office of Human Resources and Development/Certification Unit
45 W. Gude Drive, Suite 2300, Rockville, Maryland 20850
MONTGOMERY COUNTY PUBLIC SCHOOLS
MCPS Form 475-1
May 2020
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