REQUEST TO ATTEND CONFERENCE/MEETINGS THIS REQUEST FORM REPLACES THE GREEN CONFERENCE FORM AND THE PINK CONFERENCE FORM and must be completed PRIOR to registration. The school secretary will register you after purchase order has been approved. The employee must return the completed form, front and back, to his/her supervisor within 7 days of attending the conference. Employee:_________________________________ School:___________________________Date: ___________________ Conference/Meeting Title: ______________________________________________________Date: __________________ Location: ______________________________________________ Time:________________________________________ Will MSAD 71 need to hire a substitute during your conference attendance? Yes____ No____ How many days will this substitute be employed? _________________________________________________________ List account substitute will be paid from_________________________________________________________________ Estimated Costs Actual Costs Receipts MUST be Attached for reimbursement Travel/Mileage/34¢ per mile, tolls, air charges Lodging (Number of Nights _____), meals Registration Costs Other (Specify) _____________ _____________ _____________ _____________ _____________ _____________ _____________ _____________ _____________
Total ..................................................................................................... _____________
*List the account number that will be used to pay for this conference. (If this request is to come out of Site Based Professional Development Funds, the Superintendent or Assistant Superintendent’s signature is required but the school secretary will process all paperwork once approved. If however this request is to come out of District Professional Development Funds, send all necessary paperwork to the Assistant Superintendent’s Office for processing.) * ___________________________________________________________________________________________________ ATTACH REGISTRATION FORMS TO THIS REQUEST AND SUBMIT TO THE SCHOOL SECRETARY TWO WEEKS BEFORE THE REGISTRATION DEADLINE. Purpose/goal of attending this conference/meeting:
Approval: Supervisor: _________________________________________________Date:____________________________________ Superintendent or Asst. Superintendent: __________________________________Date: _________________________ (NEEDED ONLY if Professional Development Funds are to be used)
Guidelines: 1. Automobile travel will be allowed for only one car going to same conference/meeting unless over five staff members are attending. 2. Travel mileage must be figured from school, not residence, unless residence is closer. 3. Reimbursement for meals will not exceed $35 per day (three meals.). 4. One form for each person in party is necessary. 5. The individual must not be compensated by any other source for this request. (Compensated means any other financial benefit except payment/reimbursement of direct costs) I. How does this professional development opportunity support school or district goals?
II.
What impact will it have on student learning?
III.
How and with whom will you share information from this experience?
Reviewed AFTER the conference by:
Supervisor: _______________________________________________Date: _______________________________
Amended August 8, 2005
Z:\District Forms\Green Conference Form.doc