PROFESSIONAL DEVELOPMENT FUND APPLICATION FORM by DerekFine

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  PROFESSIONAL DEVELOPMENT FUND APPLICATION FORM

PLEASE PRINT

Name (if you are
applying as a group,
please provide the names
of all members)

Address



Phone
Email
Date of Application
Job Description: Please
provide a brief overview
of the duties of your
position.



Title of Activity

Date(s)
Location
Activity Delivered by:
Brief Description of
Activity (please include
a more detailed
description with this
package if applicable)




                                     Revised May 29, 2008
                                                                          2



How do you plan to share the knowledge and skills gained from this
opportunity?




What are the benefits of this opportunity for
a) Learners?




b) The Adult Learning Program?




c) You personally?




Are you including additional information regarding this opportunity with
this package?                                     Yes ____          No ____




                                                        Revised May 29, 2008
                                                                                         3

Please provide the following budget information. Accurate information is
needed, however, in some cases only estimates will available.
Fees (registration, etc…)
Travel (i.e.: rental or mileage costs
based on LNS allowance)

Accommodations

Meals (should reflect current LNS
meal allowances)

Miscellaneous (please specify)
Total amount requested
Literacy Nova Scotia rates: $0.4051/km; Breakfast: $9.00. Lunch: $10.00. Dinner $17.00

Budget Information for Group Activities
Title of Workshop:

Duration of Workshop:

Number of Participants:
Presenter Expenses
    Fees/Honorarium
    Travel Expenses
    Accommodations
    Meals
    Photocopying

Participant Expenses
     Travel Expenses
     Accommodations
     Meals




Miscellaneous Expenses
    Facility Rental
    Catering
    Other (please
       specify)


Total Expenses:

                                                                   Revised May 29, 2008
                                                                                           4




Have you, individually or as part of a group, received funding from the ALP
PD fund before?                                     Yes ____         No ____
If yes, provide the date of the PD activity: _________________________
Title of Previous Activity:      ____________________________________

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I agree to be included in a PD database upon successful completion and to
provide sharing opportunities based on my participation in the professional
development.

_______________________________
Name of Applicant: please print

________________________________                      ______________________
Signature                                             Date

As supervisor for the above named applicant, I have reviewed this
application for Adult Learning Program professional development funding
and recommend approval of the application.

_______________________________
Name of Supervisor: Please print

________________________________                      _______________________
Signature                                             Date




                                                                     Revised May 29, 2008
                                                                                           5

--------------------------------------------------------------------------------------------
(For Professional Development Committee Use Only)

Date application received
Date reviewed
Approved (yes or no)
Rationale:




Amount of funding approved
Date final package received
Date reimbursement cheque
sent


Comments:




                                                                     Revised May 29, 2008

								
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