Surveypoint

1.1

MATC Email

1.2

Name

First Name

1.3

Name

Last Name

1.4

MATC Office Phone Number

Phone Number

1.5

Personal Emergency Contact Number - (FOR OFFICE USE ONLY -this number will not be published or provided to students)

Phone Number

1.6

Instructional Department - (example - ACCTG, BADM, etc.)

1.7

Faculty OnCampus Office Hours Type (please select one)

1.8

If teaching semester quarter classes please select one of the following. (If both quarters are drastically different please submit an additional form for quarter two.)

1.9

Grand Total Hours from hours entered in the above declaration table. For full-time faculty grand total should be 32 hours minimum not including overload. Total from above table will be calculated automatically.

1.10

MATC Office Room # (Primary)

1.11

Primary Campus Location

1.12

Days at Primary Campus

1.13

Secondary MATC Office Room # (if applicable)

1.14

Secondary Campus Location (if applicable)

1.15

Days at Secondary Campus (if applicable)

1.16

Health Time Report -Form Fill

MATC Email

Name

Name

MATC Office Phone Number

Personal Emergency Contact Number - (FOR OFFICE USE ONLY -this number will not be published or provided to students)

Instructional Department - (example - ACCTG, BADM, etc.)

Faculty OnCampus Office Hours Type (please select one)

If teaching semester quarter classes please select one of the following. (If both quarters are drastically different please submit an additional form for quarter two.)

Grand Total Hours from hours entered in the above declaration table. For full-time faculty grand total should be 32 hours minimum not including overload. Total from above table will be calculated automatically.

MATC Office Room # (Primary)

Primary Campus Location

Days at Primary Campus

Secondary MATC Office Room # (if applicable)

Secondary Campus Location (if applicable)

Days at Secondary Campus (if applicable)

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