Professional Development - Travel/Conference Funding Request Application

COLLEGE OF THE CANYONS

Professional Development Travel / Conference Funding Request Application

Name:	Department/Division:
Job Title/Classification:	Campus Extension:
Conference/Workshop:
Conference Date (s):	Conference Location:

Note: This form must be submitted along with a REQUEST FOR TRAVEL AUTHORIZATION form. Please attach brochure (or photocopy) providing registration costs, and any other documentation related to the travel. For request to be considered for funding, approval process must be initiated at LEAST 30 DAYS PRIOR to the event date.

Activity must meet on of the AB 1725 approved funding criteria for professional development activities. Please check all areas that most appropriately describe this conference on the submitted page.

Total amount requested from Professional Development (max award $500/year): $

I certify that this is an accurate indication of cost. If this request is approved, I agree to submit proof of attendance, required documentation, and a Travel/Conference Expenditure from (10) days after my return.

Signature of Applicant: _____________________ Date: ________________________

NOTE: ONCE YOU SUBMIT THE FORM, PLEASE PRINT AND RETURN TO THE PROFESSIONAL DEVELOPMENT OFFICE. BE SURE TO CHECK ALL FIELDS ON THE SUBMITTED PAGE BEFORE PRINTING.

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