Professional Development Fund
Application for Classified Employees
Date: ____________________
Name (print or type):
_______________________________________________
Title: ______________________Dept.
________________ Local Telephone: ________
Peoplesoft #_________________________ Address to
send reimbursement___________________
Title of educational event (attach a coy of agenda,
brochure, or program): ________
_______________________________________________________________
Dates and Location:
________________________________________________
Brief description of reason for attending and how
attendance will benefit you, the community, and/or the University (if
need be, staple an additional sheet to the form with your
description:______________________________________________
______________________________________________________________
Proposed Budget
| Registration |
$_____________ |
| Transportation (submit copy of travel quote) |
$_____________ |
| Lodging (room rate ____ x number of nights ___) |
$_____________ |
| Meals |
$_____________ |
| Tuition/Books* Supplies** |
$_____________ |
| Other (explain) |
$_____________ |
|
TOTAL |
$_____________ |
*Tuition will be reimbursed for amount
not covered by UMS tuition waiver. Books will be reimbursed minus
tax after the textbook refund deadline. (Employees requesting a
textbook reimbursement may also use a CEAC IDO to purchase their books.)
**As Directed for class
Proposed Funding Strategy
| Departmental Funds: (attach document
outlining matching support) |
$_______________ |
| Other Campus Funds: |
|
|
Please List: ___________________________ |
$_______________ |
| Personal Funds |
$_______________ |
|
TOTAL |
$_______________ |
Amount requested from CEAC: $ _______________
Employee signature: _________________________________________
Supervisor's signature: ________________________________________
Submit to: Paulette Ferland, 114 Armory Memorial Gym
Sharon Steele, 211 DP Corbett
Faye Boyle, 101 Fernald
Lori Watson, 125 East Annex
Application acceptance is ongoing, with notification of funding as
soon as possible.
CEAC approved date: ________ By: __________________
Amount $_______