Special Circumstance Waiver Form printable pdf download

This form is to be completed by an administrator, not by the substitute candidate.

Special Circumstance Waiver

20___-20___*

This waiver application is for the following non-union Berkeley Unified School District substitute teacher who

has special skills or credentials that make this substitute teacher the best possible candidate for the

assignment.

Substitute Teacher Information

Name: ____________________________________________________________________________________

Address: __________________________________________________________________________________

Phone #: _______________________ E-mail: ____________________________________________________

This request is for the substitute teacher named above to be pre-assigned to the teacher(s), school(s) or

subject(s) listed below for the 20___-20___ school year:

School(s): __________________________________________________________________________________

Subject(s):__________________________________________________________________________________

Teacher(s) (if applicable):

___________________________________________________________________________________________

Department(s): _____________________________________________________________________________

The site administrator or designee must explain below the special circumstances that make this substitute

teacher uniquely qualified for this position:

___________________________________________________________________________________________

The principal or designee’s signature: _________________________________Date: ______________________

It is the administrator’s responsibility to send this form to the Berkeley Federation of Teachers at bft4tchr@lmi.net or

by fax to 549-2308 for approval by the BFT Union President. All special circumstance waiver substitute teachers are

BFT bargaining unit members.

If the Special Circumstance Waiver is approved, the substitute teacher’s name will be displayed in Aesop as a bargaining unit member.

*Special Circumstance Waivers must be applied for each school year.

--------------The boxes below are for BFT and Human Resources use only--------------

BFT:

Approved 

Not Approved 

Signature: _________________________________________ Date: ________________________________

Human Resources:

Approved 

Not Approved 

Signature: ________________________________________ Date: _______________________________

Special Circumstance Waiver Form