Please submit lane change request to Human Resources by October 1st

Williston Public School District #1 Lane Change Request Name: _______________________________________ Date of Request: _____________________ Address: ____________________________________ Phone: ________________________________ Current Assignment for school year ________________________________________________ School: ______________________________________ Grade/Subject: _______________________ Lane Information Current Lane and Current Step: ____________________________________________________ Date of BA/BS: _____________________ Date of MA/MS: _____________________ Proposed Lane Change for school year ______________________________________ (Please circle one)

BA+8 MA

BA+16 MA+16

BA+24 MA+24

Employee Signature: __________________________

Date: ___________________________

--------------------------------------------------------------------------------------------------------------------For office use only

MSU NDSU UND VCSU Other

_______________ _______________ _______________ _______________ _______________

Employee Notified: Date: _________________________________ By Whom/Method: _________________ Entered on SUI: _____________________

Approved Denied Reason ______________________________________________________________________ _______________________________________________________ Administrator Signature

________________________________________ Date