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 via campus mail to: Ranee Dow, Memorial Gym
Application acceptance is ongoing, with notification of funding as
soon as possible.
CEAC approved date: ________ By: __________________
Amount $_______