Work adjustment request form

Work Adjustment Request Process

The policy at CSB/SJU regarding family work adjustments is that the employee's supervisor should work with the employee to develop a plan. Based on a recommendation from the Family Friendly Policies and Practices committee, faculty members' requests for a work adjustment will be made to the Dean of the Faculty via a Forms Manager link. Only the Dean of the Faculty has access to the information.

The Dean of the Faculty will review the form, communicate with the faculty member regarding any concerns/issues, finalize a plan, and inform the faculty member’s chair of the work adjustment (without sharing any details with the chair). Given the number of faculty members with K-12 children, it is likely that it may take Pam a little while to handle the requests and communicate with faculty. Pam will prioritize making and communicating decisions for faculty teaching in the A Block, given that those faculty need clarity more urgently. She will make every effort to respond quickly, understanding how important this issue is to faculty.

Name

CSB/SJU email address

In which block(s) are you teaching?

	Block A
	Block B
	Block C
	Block D

What times and days are you teaching in block A? Leave this space blank if you are not teaching in this block.

What times and days are you teaching in block B? Leave this space blank if you are not teaching in this block.

What times and days are you teaching in block C? Leave this space blank if you are not teaching in this block.

What times and days are you teaching in block D? Leave this space blank if you are not teaching in this block.

Please share any concerns or issues that arise for you by switching to synchronous, remote teaching as your work adjustment. For example, if the time your class is scheduled for is creating problems, please describe the issue and any proposed solutions you have. The dean will reach out to you to address these issues individually..