Teacher Inservice Form

							                                                                                                              SHOULD BE COPIED
                                       APPLICATION FOR TEACHER INSERVICE                                       ON GREEN PAPER

          NAME: _______________________________________        Vendor#(Home Phone#) _______________
                               (Please Print)
          Mailing Address: _______________________________     ___________________________________
                                 (Box Number)                      (Town & Postal Code)
          Name of Inservice: _____________________________________________________________________

          Date of Inservice: _______________________________ Location: ______________________________
          Summer Institute/Conference ____ In-District Workshop/Visitation ___ Out-of District Workshop ____
          This inservice activity is relevant to the implementation of: ______________________________________

          CODE: ____________________________

          EXPENSES
                                                      effective July 2, 2008 - .49 cents/kilometer   ESTIMATED AMOUNT
          Transportation                              effective July 2, 2009 - .50 cents/kilometer
          Car__________Km @ .49(Paved): Claim an additional allowance of                             ____________________
          Car__________Km @ .54(Gravel):          $0.05 per on gravel roads                          ____________________
          Parking:                                                                                   ____________________
          Taxi/Bus/Ferry:                                                                            ____________________
          Air Fare:                                                                                  ____________________
          Accommodation:          _____ Nights @ _____ per night                                     ____________________
          Registration:                                                                              ____________________
          Meals: B = $9 L = $15 D = $21 Misc. = $5                                                   ____________________
          Other: (Please Specify)_____________________________________________                       ____________________
                                                           Total Estimated Expenses                  _____________________ * see note

           *Note: To claim your expenses for this activity, you will need to complete, sign and submit receipts
                                  using the district’s CURRENT expense claim form.
********** STAPLE AND ATTACH THE CURRENT EXPENSE CLAIM FORM TO THIS FORM. **********

           *******************************************************
          APPLICANT: I agree that, if this application is approved, I shall submit an evaluation or report on the
                     above described activity and upon request, report orally to interested staffs/employees
                     within the district.
                     This is a voluntary activity and I understand that the per diem of 1/200th of my salary
                     as per Section F, Article 5.5 of the Collective Agreement is not applicable (during
                     July and August).

                              __________________________________                                     ____________________
                                      (Applicant's Signature)                                              (Date)

          PRINCIPAL:        Please sign to indicate you are aware of this inservice activity.

                              __________________________________                                     ____________________
                                       (Principal's Signature)                                             (Date)

          DIRECTOR:         Approval for this inservice has been:

                            Granted__________                      Denied__________

                              __________________________________                                     ____________________
                                           (Signature)                                                     (Date)

                   The maximum reimbursement for claimed expenses will not exceed the amount approved.
                This amount is based on available funds and the level of in-service activities planned for the year.




          July 2008
             This form (green in colour) is to be used by teaching staff (VINTA) when requested by the Director of
                      Instruction to participate in an In-service activity, in or out of School District #85.


                      To be Reimbursed for Expenses – you MUST attach the district’s current expense claim
         form to this form. The current expense claim form should be available at your worksite or it can be
         found on the district’s website, under:
                            “Human Resources, Downloadable Forms, Accounting Forms”.
**********   STAPLE AND ATTACH THE CURRENT EXPENSE CLAIM FORM TO THIS FORM. **********
         The stapled forms are to be forwarded to the School Board Office for approval of activity. Applications are to
         be received NO LATER THAN TWO WEEKS PRIOR TO the start of the activity. Once approved, the
         paperwork will be returned to you to use to claim your expenses. Receipts are required with the exception of
         mileage and meals.
                      Any incomplete form will be returned with a request for further information.
         ********************************************************
           In order that you may estimate your anticipated expenses overleaf, a chart of the most commonly used
                                   distances (in kilometers) is included here for your use.
         From Administration Office (one way)                        From Port Hardy (one way) Kilometers
                                         Kilometers                         Campbell River                   238.0
           Port Hardy Secondary School                 1.5                  Courtenay                        284.0
           Eagle View Elementary School                1.5                  Qualicum                         347.0
           Tacan Bus Shop                              8.0                  Parksville                       359.0
           Fort Rupert Elementary School             12.0                   Nanaimo                          391.0
           Port Hardy Airport                        12.0                   Duncan                           443.0
           Coal Harbour Elementary School            18.0                   Victoria                         504.0
           Junction–Highway 19/Port Alice Road 20.0                         Vancouver                        410.0
           North Island Secondary School             42.0                   Richmond                         426.0
           Sunset Elementary School                  41.5                   Whistler                         491.0
           Cheslakees Elementary School              41.0                   Seattle                          604.0
           Port McNeill Ferry Terminal               43.0                   Kamloops                         750.0
           Sea View Elem/Jr. Secondary School        51.0                   Kelowna                          790.0
           San Josef Elementary School               51.0                   Penticton                        790.0
           Woss Lake Elementary School              104.0
         From Port McNeill (one way)
           Sea View Elem/Jr. Sec. School             52.5
                 Mileage and ferry costs will be paid up to the amount of the cheapest air fare available.
                 Distances are based on shortest routes on signed highways and do not include travel by ferry.
                 Mileage for group travel to one specific activity will be paid for one car per four participants.
         ********************************************************
                               EVALUATION OF IN-SERVICE ACTIVITY
         NAME: _____________________________________________ SCHOOL: .................................................
         TYPE OF ACTIVITY: __________________________________________________________________
         LOCATION/DATE: ____________________________________________________________________
         BRIEF SUMMARY OF ACTIVITY: _______________________________________________________
         _____________________________________________________________________________________
                                    POTENTIAL IN-SERVICE RESOURCE PEOPLE
         I recommend that the persons/topics identified below be considered for a professional activity in S.D. #85.
                TOPIC                                NAME                                  CONTACT (PH. #etc.)
         _____________________________________________________________________________________
         _____________________________________________________________________________________
         Consistent with my undertaking upon applying for this activity I would be willing to:
         _____ coordinate some form of activity on this topic
         _____ assist in the planning of an activity on this topic
         _____ discuss the activity with interested persons/staffs
         _____ make available resource materials, handouts, etc to interested persons/staffs
         _____ other ___________________________________________________________________________
                                     (Please elaborate - use separate sheet if necessary.)
         July 2008