<p> Appendix A</p><p>Instructions: 1. Print this form on cooperative or district letterhead. Attach detail information per conference/program announcement, registration form, and/or brochure. 2. Fax the completed form along with information that identifies the conference and verifies the purpose of attendance to your ISBE grant coordinator, Tammy Greco or Felicia Malloy at 217/782-0372. 3. Please know out of state travel will only be approved for district/cooperative employees. 4. This form is only required when the travel is in excess of 50 miles from the Illinois border.</p><p>OUT-OF-STATE TRAVEL FY17</p><p>NAME OF TRAVELER:______NAME OF COOP/DIST:______RCDT #:______POSITION:______DATES OF TRAVEL:______FUNDING SOURCE:PART B FT ______PART B PS ______GRANT RECIPIENT:______NAME OF CONFERENCE:______LOCATION:______PURPOSE:______ANTICIPATED COSTS:______TRANSPORTATION:______LODGING:______MEALS:______OTHER EXPENSES:______CONFERENCE REGISTRATION FEE:______SUBSTITUTES:______TOTAL:______AMOUNT OF GRANT FUNDS REQUESTED:______REQUIRED SIGNATURES: DIRECTOR OF SPECIAL EDUCATION:______PROGRAM DIRECTOR:______ISBE GRANT COORDINATOR:______</p><p>ISBE Special Education Services July, 2016</p>