Professional Development Plan - McDonald County R-1 School ...

ACTIVITY REQUEST FOR
PROFESSIONAL DEVELOPMENT ACTIVITIES
2011-2012
BUDGET CODE: PR______________________________ (filled out by PDC Chair)
Please check the CSIP goal number this activity addresses:
Goal 1 _____ To Improve Student Performance
Goal 2 _____ To Employ and Retain High-Quality Staff
Goal 3 _____ To Provide Appropriate Facilities, Support Services, and Instructional
Resources
Goal 4 _____ To Increase Parent and Community Involvement
Goal 5 _____ To Govern the District Efficiently and Effectively.
Name_____________________________________________________________
School/Teaching Assignment__________________________________________
Date of Activity_____________________________________________________
Title of Activity_____________________________________________________
(Southwest Center requires self registration)
Activity Approved by _______________________________________________
Signature of Principal, Director or Program Supervisor
____ Register myself
(Required if online)
____PDC registers me
____Southwest Center
(Must register yourself)
PDC Internal Payment:
Cost of Conference/Workshop with P.O.
Substitute Pay ($80.00)
Sub-total internal payment
$_________________
$_________________
$_________________
PDC Payment to Teacher:
Mileage _____miles x .40 = $__________________
(Southwest Center activities, $20.00 round trip)
Meals ______ days (when not supplied)
$__________________
Lodging
$__________________
Conference/Workshop (if you pre-pay)
$__________________
Sub-total amount to teacher
$__________________
TOTAL COST
$_______________
Payment Schedule:
1. Travel: Mileage expenses will be determined based on current school district rate
2. Meals: $10 for 1 st day of single conference; $25 for each consecutive day
3. Lodging: Appropriate costs, you MUST present receipt with Payment Request
4. Conference/Workshop: Paid only if the activity was approved BEFORE attendance or if required by
district/job.
5. A. Payment Request MUST be submitted within 30 contract days after the activity to be paid.
B. ALL expenses MUST be PRE-APPROVED
Explain how this activity addresses the CSIP goal(s) you selected:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
For Professional Development committee Use Only:
Date:_______________________________________
______Approved ______Denied
Reason the activity was denied: __________________________________________________________
____________________________________________________________________________________
Signature of Chair:____________________________________________________________
**MUST be submitted to building representative 30 contract days after activity.
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