CONTRACT HEADER INFORMATION. Starting Salary Placement: New hire (no experience)

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1 Page 1 of 4 C U D A E NSEA Research Negotiations Settlement Form SCHOOL YEAR For School District Thank you for taking the time to complete the new NSEA Negotiations Settlement Form. Please submit a copy of your negotiated agreement and salary schedule along with this settlement form so we can report your settlement to the best of our ability. We would prefer an electronic copy of your negotiated agreement and salary schedule be sent to Karen Hunt at karen.hunt@nsea.org. Call Karen at if you have any questions. Name Address CONTRACT HEADER INFORMATION Base Salary Starting Salary Placement: New hire (no experience) Index: Vertical Horizontal Maximum experience allowed Teacher Contract Days Student Days # Students # Teachers Teacher FTE Average Salary* Average Total Compensation** * Average Salary = total salary compensation paid by the district or Educational Service Unit, divided by teacher FTE ** Average Total Compensation = total salary compensation plus total benefits (health, dental + life + LTD) paid by the district or Educational Service Unit, divided by teacher FTE Notes: (Please list any changes in schedule structure, change in health insurance plan, rollbacks [including years & # of steps], freezes [years], etc.) Additional compensation: (tuition reimbursement, incentive pool, etc.) Ongoing One-time LIFE/LTD/VISION INSURANCE INFORMATION Life Insurance: District provides Yes No Carrier: Monthly Premium (per employee): If yes: Amount of Coverage: Amt Pd by District (per employee): Long Term Disability (LTD): District provides Yes No If yes: Carrier: Waiting Period: % of Salary Guaranteed: Income Replacement Limit: Duration of Benefit: Premium Pd by District: LTD rate (% of salary): Premium Pd by Employee: LTD rate figured on: Salary Only Salary & Insurance Vision Insurance Carrier: Select plan type: Frequency Schedule of Benefits Deductible Exists: Yes No Individual Deductible $ Dependent $ Monthly Amt Pd. Monthly Amt Pd. Prem. $ by District $ Prem. $ by District $ Individual Coverage Dependent Coverage

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3 Page 3 of 4 PAID LEAVES Type of Leave Medical Personal Emergency Bereavement Vacation Staff Development Holiday Association Adoption Leave without pay Days/Year Max. Accumulation Remarks Substitute Pay: Substitute daily pay rate (certified) Sabbatical Leave: Yes No Part-time Employees: District provides benefits? Yes No * If yes, specify type of benefits: Minimum Qualifying FTE Board Contribution: FTE Full Other DISTRICT POLICIES EXISTS NEGOTIATED BOARD POLICY YES NO Voluntary Separation/Early Retirement Grievance Professional Growth Reduction In Force Sick Leave Bank OTHER TERMS AND CONDITIONS OF EMPLOYMENT Overload and Substituting: Are employees compensated for overload (above normal class load): Yes No Compensation amount $ Are employees compensated for substituting: Yes No Compensation amount $ Work Day Information: High School Middle School Elementary Length of Teacher Day Length of Student Day Number of Class Periods Per Day Normal Teaching Load (# Periods) Length of Each Period Minutes of Planning Time Per Day Schedule Movement: Limit Vertical Steps Per Year Limit Horizontal Columns Per Year Graduate Hours in Degree Program Graduate Hours in Teaching Field Longevity Increments Provided Yes No

4 Page 4 of 4 MISCELLANEOUS INFORMATION Multi-Year Agreement Yes No Includes years: If yes, please list base for all years of agreement: Percent increase (salaries/health ins.) over : Percent increase (salaries only) over : SCHOOL DISTRICT INFORMATION PLEASE ANSWER THE FOLLOWING IF APPLICABLE: Is this a new school district resulting from a merger/consolidation? Yes No If yes, please list the names of all schools that merged, consolidated, or reorganized: SIGNATURE (One required) I have completed this questionnaire and the information provided is information of which I have firsthand knowledge and believe to be accurate. SIGNATURE OF ASSOCIATION REP POSITION/TITLE OF REPRESENTATIVE Date SIGNATURE OF SCHOOL DISTRICT REP POSITION/TITLE OF REPRESENTATIVE Date PLEASE INCLUDE A COPY OF YOUR NEGOTIATED AGREEMENT & SALARY SCHEDULE. Your cooperation in the completion of this form is vital in the completeness and accuracy of the Salary Schedule webpage, which is published for your use. We appreciate your diligence and support.

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