EmailMeForm
Professional Learning Funding Request
Is your request for travel to a conference?
*
Please select
Yes
No
Is this activity for students?
(
Not including NANCE and work study
)
*
Please select
Yes
No
Name
*
First
Last
Department/Discipline
*
Email
*
Phone/ Ext.
*
Provide an in depth description of your Professional Learning Activity:
*
Describe specifically how this event integrates with current college efforts:
-
College Goals / Strategic Directions
- Departmental/Program Goals, Objectives or Outcomes
- Basic Skills Transformation
- Disproportionately Impacted Populations
- STEM
- Career Technical Education
*
ITEMIZED BUDGET
Total Amount Requested
*
$
Dollars
Presenter/Speaker Fees
*
$
Dollars
Food/Beverages
*
$
Dollars
Materials
*
$
Dollars
Travel/Lodging/Transportation
*
$
Dollars
Other
*
$
Dollars
For your event you must fill out a
Event Form
.
If you would like to provide FLEX credit for your event fill out the
FLEX Workshop Request Form
.
Are you receiving funds from a school or department?
*
Please select
Yes
No
Funding amount from school or department
*
$
Dollars
Are you receiving funds from the Humanities Institute?
*
Please select
Yes
No
Funding amount from the Humanities Institute
*
$
Dollars
Are you receiving funds from other sources?
*
Please select
Yes
No
Funding amount from other sources
*
$
Dollars
Additional comments
