Faculty Leave/Professional Development Request Form

Faculty Leave/Professional Development Request Form

Complete this form to request absence from work due to professional obligations. This request must be submitted before the project or activity occurs.

This will also serve as the Professional Development Funds request, if those are being requested. If expenses have not been confirmed, estimates are acceptable.

Review the current SCEA contract for examples of eligible activities. Submit the completed form, including uploaded supporting documentation (acceptance letters, course descriptions, brochures, website information, proposals, etc.,). Requests for reimbursement must be made within 60 days of incurring the expense. In order to receive reimbursement for an academic course, evidence of successful completion must be attached to the reimbursement request. Requests for dissertation courses are limited to a total of two requests for the program.

Funding from Professional Develop funds is limited to $2,000 per academic year. Up to $1500 is available for one request with the balance available for a second request. Awards are dependent on funding availability.

Name Name * First Last
Email *
School *
Departure Date Departure Date * / MM / DD YYYY
Departure Time Departure Time * : HH MM AM/PM
Return Date Return Date * / MM / DD YYYY
Return Time Return Time * : HH MM AM/PM
Destination(s) *
Purpose of Trip *
Does your proposal involve travel with students? *

Does your proposal involve travel with students? Yes No
If the request involves travel with students, list the names of students who will be traveling with you.
Phone where you can be reached while off campus. Phone where you can be reached while off campus. - ### - ### ####
Describe arrangements that have been made for any classes that will be missed. *
Vehicle Notes

Be sure to contact Facility Services to make your vehicle reservation.
Number of State Cars
State Car Miles Per Car
Names of Drivers--Indicate which are students.
State Car Amount Per Car * $ Dollars . Cents
Total Cost for All State Cars * $ Dollars . Cents
Personal Car Miles
Personal Vehicle. Please consult the Travel Manual at https://bobcat.peru.edu/forms/_documents/NSCS-Travel-Manual-2022.pdf for current rates. * $ Dollars . Cents
Commercial Transportation * $ Dollars . Cents
Hotel * $ Dollars . Cents
Meals * $ Dollars . Cents
Registation Fee * $ Dollars . Cents
Other Expenses * $ Dollars . Cents
Describe other expenses (if applicable). Be sure to identify and describe student expenses in this box. *
Total Anticipated Cost (Attach supporting documentation for costs. If actual costs are not available, provide estimates.) * $ Dollars . Cents
Are you requesting funds from the Professional Development Committee? *

Are you requesting funds from the Professional Development Committee? Yes No
Amount Requested from Professional Development ($2,000 maximum per year. Up to $1500 for one request.) * $ Dollars . Cents
Describe the source(s) and amounts for additional funding for the trip, which may include personal funds. Include any amounts from SEE awards or School budgets that may be used. *
Upload Supporting Materials (acceptance letters, course descriptions, brochures, website information, proposals, etc.,)

Attach Files
The following information is used for data collection only and does not impact the approval process. *

The following information is used for data collection only and does not impact the approval process. Conference Attendance Conference Participation Member of Executive Committee Panel Chair/Participant Research Student Participation Other Other
Important Notes

This form will be forwarded to your Dean for approval of this request and then to the Professional Development Committee, if applicable. They will make a recommendation to the VPAA who will notify you of final approval. The Dean's approval of this form does not constitute approval for the trip and does not commit the College to funds other than proposed here. Final College approval for travel must occur through Firefly.