Alphabetical Listing of Forms

• Absence From Class/Duties Request (Form 1502/003)
• Academic Articulation Review Form (Form 1438/001)
• Academic Challenge/Appeal Form (Form 1440/003)
• Academic Renewal Extension Appeal Form (Form 1411/008)
• Access Card Request Form (Form 1370/002)
• Accident/Incident (Employees) Post Analysis Reporting Form (Form DA 2000)
• Accident/Incident (Visitors/Clients) Post Analysis Reporting Form (Form ORM 3000)
• Accident Report - Louisiana State Driver Safety Program Form DA 2041
• Ad Hoc Budget Committee Recommendation Form
• Annual Giving Employee Pledge Form
• Appeal for Transfer-Suspension Admission (Form 1411/008)
• Application for Academic Renewal (Form 1411/007) - Effective Fall 2017
• Application for Advanced Placement Credit (Form 1432/002)
• Application for Certificate (Form 1447/002)
• Application for CLEP Credit (Form 1433/001)
• Application for College Board AP Credit (Form 1432/003)
• Application for Credit Examination (Form 1434/001)
• Application for DSST (DANTES Subject Standardized Test) Credit (Form 1412/004)
• Application for Faculty/Staff Foundation Board Activity Grant
• Application for Graduation
• Application for Industry-Based Certification Credit (Form 1435/002)
• Application for LEAP Credit (Form 1435/002)
• Application for Proficiency Examination - Charity School of Nursing (Form 1434/002)
• Authorization for Special Travel Circumstances (Form 1380/004)
• Bookstore Charge Form (Form 1504/002)
• Budget Revision Request
• Building Inspection Checklist
• Career Pathways Development Template
• Carl Perkins Equipment Student Loan Form (Form AA-005/001)
• Catalog Change Submission Form
• Catering Request
• Certification of Employee Routine Field Travel Form (Form 1380/003)
• Change of Address/Name Form (for all Delgado employees)
• Change/Addition of Major Form (Form 1442/010)
• Change of Name Form (Form 1442/016)
• Change of Personal Information Form (Form 1442/013)
• Change of Student Record Form (Form 1442/002)
• Checklist for Potential Graduates
• Child Care Payment Agreement Form
• Classified Employees Performance Evaluation System (PES)
• Classified Full-Time Position Description (Word)
• Classified Part-Time WAE Position Description (Word)
• Classified Staff Grievance Form (SF16)
• Clinical/Practicum Student Incident/Accident Report Form (Form 2610/001)
• Committee Meeting Report Form (Form A)
• Committee Recommendation Form (Form B)
• Consent to Release Information for Person with Disability
• Contact Form for Resource Development
• Contract for Professional, Personal, or Consulting Services (Form 3311/001)
  --  ATTACHMENT 1 (Statement of Work) to Contract for Professional Services 
  -- AMENDMENT to Professional, Personal, or Consulting Services (Form 3311/001)
  -- (See Contracts for Professional Services Forms and Related Procedures)
• Contract Review Form - Civil Service Form CSCR1
• Contractual Evaluation Form for Continuing Services Contracts (OCR Form)
• Contracts for Professional, Personal, Consulting and Social Services Sample Certification Letter
• Contractual Agreement for Issuance of "Incomplete" (1441/001)
• Course Syllabus Format (Word version)
• Curriculum Proposal Cover Sheet (Form 1510/001)
• Custody Receipt - Property Removal Pass (Form 1352/001)
• Day One Guarantee Retraining Agreement (Form 1410/009)
• Departmental Bookstore Charge Form (Form 3323/002)
• Departmental Supplies Requisition (Form 3323/001)
• Departmental Wish List Application (Form 3050/002)
• Design and Print Work Order Form
• Direct Deposit Enrollment Authorization Form (LCTCS Form for EMPLOYEES)
• Direct Deposit Waiver Request Form (LCTCS Form for EMPLOYEES)
• Direct Deposit Vendor Payment Delivery Authorization Form (For VENDORS)
• Disciplinary Appeal Form
• Disclosure of Outside Employment Requiring  Approval of Chancellor or System President (LCTCS Form "B"- Word Version)
• Disclosure of Outside Employment Requiring  Approval of Chancellor or System President (LCTCS Form "B"- PDF Version)
• Disclosure of Outside Employment Requiring Approval of the Vice Chancellor (LCTCS Form "A"- Word Version)
• Disclosure of Outside Employment Requiring Approval of the Vice Chancellor (LCTCS Form "A"- PDF Version)
• Documentation of Warning (Form 2130/001) - Suggested Template
• Donation of Movable Property Form (Form 3050/001)
• Driver Authorization and Driving History Form (Form DA 2054)
• Dual/Concurrent Enrollment Application/ Application for Enrollment Using TOPS Tech Early Start Program And/Or Supplemental Course Allocations
• Dual Enrollment Maximum Hours Waiver Form (Form 1440/001)
• Duplicate Diploma Request Form (Form 1447/001)
• Electronic Message Board Request Form
• Emergency Contact Form
• Employee Exit Checklist Process
• Employee Request for Released Time to Attend Class (1412/001)
• Employee Request for Tuition Exemption (Form 1412/002)
• Employee Request for Tuition Reduction (1412/003)
• Employee Request for Tuition Reduction or Exemption CHECKLIST
• Employee Safety Rules and Responsibilties Form
• Employee Withholding Allowance Certificate - Federal (W-4)
• Employee Withholding Exemption Certificate - State of Louisiana (L-4)
• Employment Eligibility Verification Form (I-9)
• End of Semester Checkout Form (Form 2122/002)
• English Language Proficiency Report Form (PDF Version)
• English Language Proficiency Report Form (Word Version)
• Envelope Ordering Instructions
• Event Reservations
• Excellence in Teaching Nomination Acceptance Form (Form 2230/001)
• Exemption from the Classified Service - Request (Part-Time Unclassified)
• Faculty Evaluation Process Webpage:
  -- Faculty Evaluation - LCTCS Full-Time Teaching Evaluation - Part A: Job Expectations (Form 2220/003A)
  -- Faculty Evaluation - LCTCS Full-Time Teaching Evaluation - Part B: Faculty Professional Growth Form
        (Form 2220/003B)
  -- Faculty Evaluation - Classroom Observation Form (Form 2220/002)
  -- Faculty Evaluation - Sample Formative Evaluation Form
  -- Faculty Evaluation - LCTCS Full-Time Teaching Evaluation – Part C: Overall Evaluation (Form 
         2220/003C)
  -- Faculty Evaluation - LCTCS Performance Improvement Plan Form for Faculty Evaluation
       (Form 2220/003PIP, applicable for Overall Evaluation Scores Below 3 Only)
  -- Faculty Evaluation - Supervisor's Evaluation Checklist for Part-Time Faculty (Form 2220/007)
• Faculty Qualifications Verification Summary (Form 2122/007)
• Faculty Work Schedule Template (Form 2122/001)  
• Federal Ethnicity and Race Reporting Form
• Fee Waiver Form for Minisession/Flex Course (Form 1412/007)
• Financial Records System (FRS) Request for Account/Access (Form 1822/005)
• FFCRA - Request for Families First Coronavirus Response Act Leave Form (Form 2411/002)
• FFCRA - Child-School List Form (Form 2411/003)
• FMLA - Certification for Serious Injury or Illness of Covered Service Member - for Military Family Leave
• FMLA - Certification of Health Care Provider for Employee's Serious Health Condition
• FMLA - Certification of Health Care Provider for Family Member's Serious Health Condition
• FMLA - Certification of Qualifying Exigency for Military Family Leave
• FMLA - Designation Notice
• FMLA - Notice of Eligibility and Rights & Responsibilities
• Fundraising Request Form (Form 6313/002)
• Grade Change Form (Form 1441/002)
• Graduation Application Form
• Grant Concept Planning Form (Form 6310/002)
• Grant Intent Form (Form 6310/001)
• Grant Process Checklist (Form 6310/003)
• Grievance Forms for Teaching, Faculty, Librarians and Academic Counselors with Rank
• Hazard Control Log (ORM Form HC-1-90)
• Hilton Foundation Grant Equipment Student Loan Form (Form AA-007/001)
• I Contract (Contractual Agreement for Issuance of "Incomplete") Form 1441/001
• Institutional Research (IR) Request Form
• Interactive Television Teaching (ITT) Course Proposal Worksheet (Form 1452/001)
• Interpreting Request Form
• Intramural Sports/ Student Life Activities Hold Harmless Agreement
• Key Control Form (Form 1370/001)
• L-4 Louisiana Employee Withholding Exemption Certificate
• LASERS Change of Address Form
• LCTCS Parental Leave Certification Form
• Leave Request Form (Form 2400/001)
• Liberty Bank Sponsored Professional Development ‘Best Practices Series’ Grant Application
• Louisiana Workman's Compensation Second Injury Board Post Hire/Conditional Job Offer Knowledge Questionnaire
• Maintenance Work Order
• Master Syllabus and Course Syllabus: Format and Guidelines
• -- Master Course Syllabus Format (Word version)
• -- Course Syllabus Format (Word version)
• Meritorious Commendation Application - Verification of Eligibility Form (Form 2322/001A)
• Mini-Grant Application Forms (Forms 6311/001, 002, and 003)
• Mini-Grant Application Sample Proposal
• Mobile Communications Agreement and Request Form (Form BAA-E001)
• Mobile Communications Device Acceptance Agreement Form (Form BAA-E002)
• Name Change Form (Form 1442/016)
• Non-Credit Course Change Request Form (see Form Instructions)
• Non-Credit Course Creation Request Form (see Form Instructions)
• Notice of Cancelled Class (Form 1442/001)
• Office Hours Form - Faculty Work Schedule Template (Form 2122/001)  
• OGB (Office of Group Benefits) Enrollment/Change Form
• OGB (Office of Group Benefits) Flexible Benefits Plan - Flexible Spending Arrangement Enrollment Form
• OGB (Office of Group Benefits) Health Savings Account (HSA) Form
• Online Printing Web Site Use Instructions
• Oral and Written Proficiency Form (Form 2122/004)
• Overtime/Compensatory Leave Approval Form (Form 2400/005)
• Overtime - Statement of Agreement or Understanding for Classified Employee Compensation for Overtime Work
• Pager Contract Form
• Parental Leave Certification Form (LCTCS Form)
• Passenger Liability Waiver (Form 1382/002)
• Permission to Enroll at Another Institution for Program/Degree Requirements for Graduation (Form 1413/008)
• Personnel Action Form (Form 2200/002)
• Petty Cash Check Voucher Request (Form BAA-A01/001)
• Petty Cash Reimbursement Request (Form BAA-A01/002)
• Prior Learning Assessment (PLA) Proposal Form (Form 1510/004)
• Portfolio Worksheet and Assessment Evaluation Form for LEAP (Form 1435/001)
• Position Control Form (Form 2200/001)
• Power of One Grant Application Form (Form IA-001)
• Power of One Grant Proposal Evaluation Form (Form IA-002)
• Professional Development Presenter Grants Application & Information
• Professional Services Contract (Form 3311/001)
• Project Submission Checklist
• Promotion-In-Rank Application - Verification of Eligibility Form (Form 2321/001A)
• Promotion-In-Rank Division Committee Individual Recommendation Form (Form 2321/002)
• Promotion-In-Rank Recommendation Form for Division Promotion-In-Rank Committee (Form 2321/003)
• Promotion-In-Rank College Committee Individual Recommendation Form (Form 2321/004)
• Promotion-In-Rank Recommendation Form for College Promotion-In-Rank Committee (Form 2321/005)
• Promotion-In-Rank Academic Affairs Promotion Appeals Council Individual Recommendation Form (Form 2321/006)
• Promotion-In-Rank Recommendation Form for Academic Affairs Promotion Appeals Council (Form 2321/007)
• Proof of Immunization Compliance
• Proposal for Use of Student Technology Enhancement Program (STEP) Fee (Form 1837/001)
• Public Records Request Authorization - Delgado Human Resources
• Purchasing Card Action Form (Form 3300/013)
• Purchasing Card Cardholder Agreement Form (Form 3300/011)
• Purchasing Card Cardholder Enrollment Form (Form 3300/010)
• Purchasing Card Issuer's Statement of Disputed Item
• Purchasing Card Missing Document Affidavit Form (Form 3300/012)
• Purchasing Card Notification of Discrepancy - Violation Form (Form 3300/015)
• Purchasing Card Unauthorized Purchase Form (Form 3300/014)
• Receiving Report (Daily Storeroom Material Receiving Report) Form No. 14
• Recoupment of Overpayments Statement of Understanding Form (LCTCS Form)
• Reference Check Form
• Refund Request Form (Online Form - see Adjustment of Tuition webpage)
• Refund Request Form (Paper version )
• Reimbursement for Personally-Owned Vehicle Use (DA MV7)
• Relocation Request for Equipment/Furniture (1352/002)
• Request for Change of College Catalog for Degree or Certificate Requirements (Form 1413/002 - Word Version)
• Request for Change of College Catalog for Degree or Certificate Requirements (Form 1413/002 - PDF Version)
• Request for Family and Medical Leave Act (FMLA) Leave (2411/001)
• Request for Field Trip (Form 1502/002)
• Request for Permission to Serve Alcohol (Form 1475/001)
• Request for Reconsideration of Library Materials (Form 1451/001)
• Request for Released Time (Form 2420/001)
• Request for Sanitization of Data Storage Device (Form 1822/009)
• Request for Student Record Information (Form 1442/005)
• Request for Transcript Form (See "Request A Transcript Webpage" for more information.)
• Request to Create Account (Form 3300/001)
• Request to Defer or Withdraw Graduation Application (Form 1440/005)
• Request to Inspect and Review Education Records
• Request to Organize (Charter Approval for Proposed Student Organization (Form 1470/001)
• Request to Prevent or Allow Disclosure of Directory Information
  --See Family Education Rights and Privacy Act
• Requisition for Purchase Form (Form 3300/001)
• Residency Appeal Form (Form 1411/012)
• Residency Reclassification Application Form (1411/010)
• Response to Student Complaint (Form 2530/002)
• Response to Student Grievance (Form 2530/004)
• Retirement Membership Plan Disclosure Form
• Salary Deferred-Payback Option Form
• Semester Accommodations Request Form (Submitted Each Semester/Session) 
• Service Learning Mini-Grant Application Form
• Service Learning Stipend Application Form
• Shared Sick Leave Donation Form (Form AD-007/01) (*See Shared Sick Leave Program Policy)
• Shared Sick Leave Application Form (Form AD-007/02) (*See Shared Sick Leave Program Policy)
• Software License Compliance Certification Form  
• Special Topics Course Proposal Cover Sheet (Form 1510/003)
• Statement of Agreement or Understanding for Classified Employee Compensation for Overtime Work
• Student Accessibility Services Student Agreement
• Student Accessibility Services Student Intake Form 
• Student Accessibility Services Testing Accommodations Form (Form 1468/002)
• Student Complaint Form (Online)
• Student Course Load Override Form (Form 1440/001)
• Student Field Trip Waiver (Form 1502/001)
• Student Government Association Officer Tuition Waiver Agreement (Form 1471/001)
• Student Grievance Form (Form 2530/003)
• Student Information System (SIS) Request for Account Access (Form 1822/003)
• Student Referral Form (Online)
• Student Technology Enhancement Program (STEP) Proposal Eligibility Form (Form 1837/002)
• Student Waiver of Services/Accommodation Form (Form 1468/003)
• Substantive Change Review Form (Form 1510/002)
• Request for Course Substitution(Form 1413/007)
• Summer Service Employment Form for Nine-Month Full-Time Faculty (Form 2123/001)
• -- Summer Session Pay Scale
• Telephone Reference Check Sample Form
• Temporary Property Storage Form (Form 1352/003)
• Transcript Request Form (See "Request A Transcript Webpage" for more information.)
• TRSL Enrollment Application/Notification Form
• TRSL Name Change Request Form
• Tuition Increase/Fee Hardship Appeal Form (Form 1412/011)
• Unclassified Faculty/Staff Position Description Form (Form 2200/005)
• Unclassified Staff Performance Evaluation and Planning Form (LCTCS Form)
• Vehicle Rental Request (State Contracted Vendor) Form (Form 1380/005)
• Vehicle Rental Request (Delgado Vehicle) Form (Form 1382/001)
• Verification of Employment Form
• Veteran, Service-Member, Dependent, Spouse Non-Resident Tuition Waiver Request Form (Form 1411/011)
• Violence Incident Statement
• Voluntary Self-Identification of Disability Form - LCTCS Form 
• W-9 Request for Taxpayer Identification Number and Certification - Internal Revenue Service Form
• Web Site Content Management System (CMS) Authorized User Agreement (Form 1823/001)
• Withdrawal From College Form (Form 1442/003)
• Workforce Development Non-Credit Refund Request Form (Form WFD-001/01)