Distance Learning Compensation Request Form

First Name: *

Last Name: *

Campus E-Mail: *

Phone Number: *

Division *

Department *

Type of Faculty: *

Full Time

Lecturer

Adjunct

Other

Term: *

Year: *

This form is designed for one selection per submission. If you are entitled to additional compensation, please submit an additional form.

Please select the specific request for compensation. Compensation is determined by the latest BCCFA agreement.

Course # (ex. WRT-101-198): *

Please select One: *

Enter the word in the image *
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