SAMPLE XYZ Charter
719
555/555-1234
End of Year Check-Out
To: Teachers
From: Chief Education
Officer
Date:_____________
Below is a checklist of items that need to be completed before you leave on (last day of work) . The individuals authorized to release you from the responsibility for the below listed items must initial in the space to the left of the item on this form. In order for you to be sure of who has the authority to initial, their names appear below the respective items. Please deliver this form to the Director when complete.
______Grades
______Classroom inventory sheet
______Supplemental materials (non-textbooks)
______Complete appropriate textbook forms and check in textbooks
______Turn in your paper grade book
______Remove all charts, pictures, student work and staples from classroom and hallway walls
______Pack all classroom materials/supplies
______Turn in all room/building keys
______Turn in copy of semester exam and answer key
______Computer
Teacher Name: _________________________________Phone:__________________________
Address: ______________________________________________________________________
Summer Address: _______________________________________________________________
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