* Required

SUPERINTENDENT CONTRACT SURVEY

District Namerequired

DRG:

CONTRACT DURATION

From: (mm/dd/yyyy)

To: (mm/dd/yyyy)

Reopen When (mm/dd/yyyy)

Years of Experience

Years Within District

SALARY

Year (14-15)

Year (15-16)

Year (16-17)

Year (17-18)

Annuity?

yes no

Annuity Amount

Sign On Bonus?

yes no

Sign On Bonus Amount

Income Protection?

yes no

Income Protection Amount

FRINGE BENEFITS

Leave:

Sick Days/Yr

Cummul to Next Yr?

yes no

Max:

Vacation Days/Yr

Cummul to Next Yr?

yes no

Max:

Personal Days/Yr

Cummul to Next Yr?

yes no

Max:

Unused days paid upon death, retirement, resignation, termination?

yes no

Max:

Retirement?

yes no

Conditions:

Continuing Health Benefits?

yes no

Conditions:

Early Retirement?

yes no

Conditions:

Minimum Age:

Years of Service:

FRINGE BENEFITS CONTINUED

Moving Expenses:

yes no

Amount:

Travel Reimburesement:

Mileage:

$$ Allowance/Yr:

Car Provided?

yes no

Professional Associations:

Max Amount or Limit

Tuition Reimbursement?

yes no

Max Amount:

Cell Phone Provided?

yes no

HEALTH BENEFITS

Health Insurance?

yes no

Dental Insurance?

yes no

How is it Paid?

Plan Type:

Offered:

If Other:

Selected:

If Other:

Option to Continue after retirement?

yes no

Option for family after death?

yes no

Disability:

Short Term Coverage?

yes no

Max Days:

Long-Term Coverage?

yes no

Max Days:

Life Insurance?

yes no

Portable?

yes no

Death Benefit?

yes no

Conditions:

Superintendent Contract

If available, please attached a copy of the contract for our records.

Max file size: 10 MB

Your Name: required

Title:

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