APPLICATION FOR PROFESSIONAL DEVELOPMENT FUNDS

(Attach additional sheets or information If necessary.)

                   Name: ____________________________________________ 

 Department/University Mailing Address:

 

  E‑mail:                                                                                          

  Phone:              

                   I.                    Briefly describe the activity for which you are requesting funds.

                              Activity:

 

                             Place:

                             Date:

                  II.                Briefly describe the objectives of this activity.

 

 

                  III.        If a conference or convention:

Are you a member of the organization? Yes___ No___ NA ___

Are you a presenter or functioning in some other official capacity?

                  Yes ___ No ___ If so, please briefly describe.

 

Breakdown of expenses:

Requested

Dean Use Only:
Dean Grant

FDC Use Only: FDC Grant

Registration/tuition

 

 

 

Lodging

 

 

 

Transportation
      Air

 

 

 

      Ground

 

 

 

Convention materials

 

 

 

Publication/printing costs

 

 

 

Other (describe)

 

 

 

 

TOTAL

 

 

 

 

________________________________       _________
Signature of Requestor                                     Date                  

________________________________       _________
Division Chair Person                                       Date

________________________________       _________
CFO                                                                Date