Application for Professional Development

CPS APPLICATION FOR PROFESSIONAL DEVELOPMENT, TRAVEL/MEETING, OR CONFERENCE

Directions: Step 1 – Requestor complete form and sign A) If Travel, Meeting or Conference, complete Page 1 ONLY and attach brochure or flyer B) If Professional Development through Mayerson, complete Pages 1 and 2 Step 2 – Acquire Supervisor, Accountant, and Grant Director/CAAS Rep (if needed) signatures Step 3 – If travel, meeting, or conference, Grants-Clerical Support will give log # and maintain original document Step 4 – If through Mayerson, Mayerson will give log # and maintain original document

School or Department: DATE:

Requested by: Dates of Activity:

Place of Activity: Person(s) Attending: Course or PD Title:

Estimated Cost Docume Per nt Description Amount Per Person X Account Code / Payroll Alias  Attache Person # of d persons APPLICATION FOR PROFESSIONAL DEVELOPMENT - MAYERSON Substitute Detailed $ Teacher Teachers List Teacher Extended Personnel $ Time Req Consultant Fee Consultant $ Total Offer Copies $

Materials / Supplies $ APPLICATION FOR TRAVEL, MEETING OR CONFERENCE - CPS Brochure Registration Fees $ $ or Flyer Transportation $ $ (airlines, bus, etc.) Mileage – personal $ $ car Lodging $ $

Meals $ $ Substitute Teacher(s) needed TOTAL $ $ $

Approval Signatures (Printed Names Will Not Be Accepted)

Requestor Date

of 4 APD Form (Revised 11-2014) Supervisor Date

CPS Budget Office Accountant Date

CPS Director, Grants Administration Date

(required only if grant funded)

CPS CAAS Representative Date (required only if CAAS funded)

of 4 APD Form (Revised 11-2014) PLANNING PROFESSIONAL DEVELOPMENT MAYERSON ACADEMY

NOTE: The following description provided here will be posted online.

Statement of Needs/Justification – WHY

If this PD activity requires multiple courses with different audience participants at each course, a separate course number is needed for each group of audience participants. Multiple sessions of the same course number require participants to attend all sessions.

# of Participants per Course: ______# of Courses needed:______# of Sessions per Course:______

Course # Target Session Date(s) Session Time(s) Session Conta (to be assigned) Audience per Course # From/To Location ct per Course # Hours (1)

*Note: University Graduate Credit must be requested and approved through Mayerson Academy prior to the start of the activity.

Technology Food: Materials: Laptops # ______ Prestige Catering   Provided by presenter (Purchase Requisition attached) Promethean ______  Purchase Requisition  Other (to be reimbursed) attached

NAME OF PRESENTER:

NAME OF PAYEE (TO WHOM PAYMENT IS MADE, IF DIFFERENT THAN NAME OF PRESENTER):

ADDRESS OF PAYEE:

Phone(s): e-mail:

Consultant Fee: Consultant Travel/Lodging

of 4 APD Form (Revised 11-2014) This professional development meets the Mayerson Academy Professional Development Standards.  YES  NO

Professional Development Specialist Date

of 4 APD Form (Revised 11-2014)