1

REVISED: December 2015

RICH TOWNSHIP HIGH SCHOOL DISTRICT 227 REQUEST FOR PROFESSIONAL DEVELOPMENT FUNDS

Name: Date: Campus: Please indicate with ü to which of the following District 227 Goals and Objectives this request applies.

□ Goal #1…Students • Every student is prepared for college/career success.

□ Goal #2…Instructional Program and Support • Our instructional program equips diverse learners to achieve their full potential.

□ Goal #3…Staff • We support and develop high quality, high performing staff.

□ Goal #4…Business Operations • High Quality services efficiently and effectively support the educational success of students.

□ Goal #5…Partnership • Productive partnerships require transparent communications with parents and other

stakeholders, promoting student and organizational outcomes.

1. Name of Activity. Describe in detail. (Attach brochure or printed info.)

2. What is your goal in attending this conference? How will your attendance benefit students? How will it impact student achievement?

3. Is this activity related to any district, building, or departmental improvement goals? please explain.

4. What will be the expected outcomes of this activity? (i.e., revised lesson plans,

teaching strategies, curriculum materials, or procedures)

5. Dates of attendance at program/conference (maximum 3 school days).

Circle days of week you will be absent from school. M T W TH F

2

6. Location of program or conference.

7. Date you were last granted funds for professional development

through District Professional Growth Committee. 8. Date you last attended this similar program or activity.

9. List your current teaching, extra duty assignments, extracurricular activities, and

committee memberships. 10. Estimated costs:

Transportation: Automobile only (# of miles X $.575/per mile) $ Mileage is calculated from home campus to the destination of conference.

For air, train or bus Shuttle to/from airport maximum $40.00 round trip. (Selected airport should be closest to your venue and car rental $ expenditures are not reimbursed.) Flight fare can not exceed cost for lowest non-stop flight fare. Luggage up to $25 per direction (when applicable) $ Parking fee when driving to a conference up to $20.00 per day $

Registration: (attach form) Submit member rate only (Membership fees are the responsibility of the staff member) $

Lodging: nights @ $ $ Cost should reflect shared room cost with taxes and fees (attach documentation)

Will you be rooming with someone? (circle one) Y or N staff member name:

Meals - $50.00 per day $ 1. Itemized receipts are required for reimbursement upon completion of travel. 2. Credit card receipts will not be accepted unless they are itemized. 3. Tip and gratuity will be reimbursed up to 20% and must be written on food receipt. Total food purchase may not exceed $50.00. 4. NOTE: Cost for alcoholic beverages WILL NOT be reimbursed. Materials – Approved items will be district property. $

GRAND TOTAL $

NOTE: Approved staff that are not able to attend workshop must notify the DPG Chair, Alexandria Wilks at awilks@rich227.org and Ana Zambrano at azambrano@rich227.org ASAP!!!

It is advised that applicants contact a Professional Growth Committee member prior to submitting applications to District Office to eliminate possible errors. Possible errors can cause your application to be denied by the

committee.

3

Teacher: Campus: Liaison Administrator’s Comments and Statement of Priority:

Liaison Administrator’s Signature Date

Principal’s Comments and Statement of Priority:

Principal’s Signature Date

Note: Request MUST be routed through the Liaison Administrator and Principal.

****Reimbursement submissions deadline 30 days after date of conference.

Rev. 12/2015-AZ