Outreach for K-12

Electrical Technology Center, Rm. 136 · (570) 320-8003

Career Day Session Commitment Form

Please complete this form if you want to conduct a session on Career Day.

Career Day activities take place from 9 a.m. to 2 p.m.
Spring Career Day is for students in grades 7 - 9 ONLY.
Fall Career Day is for students in grades 9 - 12 ONLY.

Completing this form indicates your commitment that you will deliver the activities as specified.

Registration Information * = optional fields

Name Legal first name
Legal last name

Contact Information E-mail address
DIF number*
College extension*

School Select your school*
Other*

Title of activity
Detailed description (Sell your activity! Attract students! This will be listed in the flyer!)
Length of sessions: 45 minutes

After you complete this form, you will be given an opportunity to select time slots for sessions of this activity. The time slots available will be based on the "length of sessions" you selected.

Room and building where activity will be held Room #
Building

Is the room a computer lab? Yes No

Maximum number of participants that each session can accommodate

Number of 6 foot tables and chairs required

(Outreach for K-12 will do work order)

Tables
Chairs

If you need any laptops, you need to complete a form at least a week in advance through Information Technology Services web page: http://www.pct.edu/its/Laptop/Guidelines.htm

Will you use any instructional or projection equipment? Check all that apply: Networked computer and data projector TV/VCR Overhead projector Projection screen Other [Please specify] Other Equipment

Will you be bringing any instructional or projection equipment with you to use? Check all that apply Networked computer and data projecto TV/VCR Overhead projector Projection screen Other [Please specify] Other Equipment

Do you intend to use student workers as part of your session? Yes No

If yes, how many do you plan on using?

Each student worker is provided with a $30 gift certificate at the College Store. They are expected to be available for 5.5 hours.

There are some funds available for curricular supplies. Please call Outreach for K-12 at (570) 320-8003 or e-mail CareerEd@pct.edu to discuss and to coordinate the ordering of supplies.

Are you regularly scheduled to work at Penn College on Career Day? Yes No

You MAY BE eligible to receive pay for up to 5.5 hours for working on Career Day. Please complete the following questions so that we can process your recommendation for hire.

Gender Male Female

Employee Classification APT Faculty Classified

Do you have a relative that is an employee at Penn College? Yes No

Relative Information

If yes, we need to know the relationship and their work area.

Name
Relationship
Work area

Please select your race

Regularly scheduled Penn College ARE NOT eligible to receive extra pay for working on Career Day.

The following will be provided:

Payment with the following terms: $25.00 per hour, not to exceed 5.5 hours.
Pay is based on the delivery of an independent session; hence if two faculty co-present at the same session, the pay will be split between the two.

You agree to provide the activities as detailed below according to the following conditions:

A Career Day activity to be delivered as defined on this form.
In order to be paid, you must fill out a time sheet.
You MUST have requested pay via this form prior to the event.

Please note: Because of budget limitations, Outreach for K-12 reserves the right to determine which activities will be funded.

One College Avenue
Williamsport, PA 17701

(570) 326-3761
(800) 367-9222

webmaster@pct.edu

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