DEPARTMENT OF SOCIAL SERVICES OTHER LOCAL DONATED CONDITION STATEMENT

2007-08 Staff Development/CSPD Request/ Reimbursement Form Name_____________________________________________________________ Building: HAFRC Name of Event_____________________________________________________ Date of Event___________ (Attach the information about the workshop/conference you are requesting to attend) Location of Event____________________________________________________________________________ *NOTE: For special education staff, return the form to the Principal for approval Expenses: Itemized Receipts Required for Reimbursement Projected Cost Registration Cost Lodging Mileage (.25/mile) Meals $5 breakfast, $7 lunch, $10 dinner Amount Requested Actual Cost Substitute Wages & Benefits Certified : $101.39 Non-certified: $10.46 per/hour Staff Hours/Cost Other TOTAL REQUESTED ____ Site Approved ALLOWED REIMBURSEMENT Staff Dev. Comm. Approved ____ Exemplary (Best Practice) ____ CSPD - Special ED Check The District and Site Goal Request Aligns With: ___ To facilitate staff involvement in professional development activities that will enhance the delivery of instruction to students. ___ To educate staff on current technology tools available to them for classroom instruction / classroom management. ___ Provide opportunities to improve staff collaboration across the school district. ___ To increase collaboration in an effort to improve programming for all families with early childhood aged children. ___ To increase the understanding and use of technology in early childhood settings. ___ To increase staff knowledge of best practice for working with both children and families in the field of early care and education. ____ Site Approved 01- 025 -640-000-306 - _____ 366: travel ____ Exemplary (Best Practice) 01-_____-640-000-307 - _____ ____ -420-640-419 _____ 01- 005CSPD - Special -ED 01- 005 -420-640-419 - _____ CODES TO USE ON TIME SHEET AND/OR EXPENSE REPORTS 145: teacher subs 146: aide subs 171: secretary subs 185: staff paid Applicant’s Signature_________________________________________ Date____________ Approved by _________________________________________ Date____________ Copies of this form need to be attached to (1) time sheet/absence report, (2) purple expense reimbursement form with receipts and (3) registration check request

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