CE Contract Planning

Director(Required)

Semester(Required)

Beginning Date(Required)

Census Date

End Date(Required)

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Days prior to start date

Explanation for Late Submission

Course Code(Required)

Tier

Class Title(Required)

Course Type(Required)

Select All
Basic Skills Plus
CECCP (High School)
Certification Course
Instant Enrollment
Local Registration
Moodle
Print Certificate

Credentialing Agent

Method of Instruction(Required)

Face-to-face Hours

If none, enter (0).

Online Hours

If none, enter (0).

CEUs(Required)

Yes
No

Location

Rocky Mount Campus
Tarboro Campus
Other

Rocky Mount Building

Tarboro Building

Rocky Mount Room

Tarboro Room

Location

Start Time(Required)

:

End Time(Required)

:

Break(Required)

Class Meets(Required)

Select all days of week class plans to meet.

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Class runs for how many weeks?(Required)

Minimum Number of Students(Required)

Least amount of students required for class to make. If no minimum, enter (0).

Maximum Number of Students(Required)

Most amount of students before class is full. If no maximum, enter (0).

Funding Method(Required)

Discount Waiver

CE Basic Skills Plus
CE HRD
CE Paid Fireman
CE Paid Law Enforcement
CE Paid Rescue Squad
CE Volunteer Fireman
CE Volunteer Rescue Squad
Other
None

Explain if other

Tuition

Self-support Amount

ACCFE - Accident Insurance

CEMAL CE - Malpractice Insurance

XCPRC - CPR/FA/AED Card Fees

CAPS Fee

Campus Access, Parking, and Security

Taylor - Budget Codes

Ashman - Budget Codes

House - Budget Codes

Sledge - Budget Codes

Norville - Budget Codes

Abrams - Budget Codes

Smith - Budget Codes

Spence - Budget Codes

Webb - Budget Codes

Spence - Budget Codes

Public Safety - Budget Codes

⚠️ A Worker Classification worksheet must be completed and approved before a Professional Service Agreement can be submitted.

Company Name

CompanyID / FedID#

Contact Person

Address

Street Address Address Line 2 City State ZIP Code

Amount of Pay

Contract

Overload
Part-time
Prorated

Number of Instructors

1
2
3+

Instructor Name

Instructor ID

Rate of Pay

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Hours (old field - replaced with ID 164)

Hours(Required)

Total Payment

Months worked(Required)

Select all that apply.

Hours worked in January

Hours worked in February

Hours worked in March

Hours worked in April

Hours worked in May

Hours worked in June

Hours worked in July

Hours worked in August

Hours worked in September

Hours worked in October

Hours worked in November

Hours worked in December

Total Hours Worked

Instructor 2 Name

Instructor 2 ID

Inst. 2 Rate of Pay

Instructor 2 Hours

Instructor 2 Total

Instructor 2 Months worked

Select all that apply.

Instructor 2 Hours worked in January

Instructor 2 Hours worked in February

Instructor 2 Hours worked in March

Instructor 2 Hours worked in April

Instructor 2 Hours worked in May

Instructor 2 Hours worked in June

Instructor 2 Hours worked in July

Instructor 2 Hours worked in August

Instructor 2 Hours worked in September

Instructor 2 Hours worked in October

Instructor 2 Hours worked in November

Instructor 2 Hours worked in December

Inst. 2 Total Hours Worked

Add information for each additional instructor

FirstName LastName, Instructor ID, Contract Type (Overload, Par-Time, Prorated), Rate of Pay, Hours Worked, Months worked, total hours worked each month, and total payment.

Special Instructions

Supporting Documents

Drop files here or

Max. file size: 300 MB, Max. files: 3.

Confirmation(Required)

Please review your form.

I have carefully reviewed this form, and confirm that all information is accurate.

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CE Contract Planning

Continuing Education Contract Planning

⚠️ A Worker Classification worksheet must be completed and approved before a Professional Service Agreement can be submitted.