CCSU-SUOAF AFSCME
MINORITY RECRUITMENT AND MENTORING COMMITTEE APPLICATION
Article 3.2 of the CSU-SUOAF AFSCME collective bargaining agreement provides financial
resources to provide direct and continuing support for obtaining credentials/qualifications by
minority appointees to the SUOAF bargaining unit. If you are interested in financial assistance,
attend professional conferences, pursue an advanced degree, and/or obtain professional
certification or other training or education you may use this form to apply for funds.
Funds are awarded based upon available resources and the intent of article 3.2 of the contract.
When support for obtaining credentials/qualifications is provided, an individual agreement is
written describing the nature of the support and specifying that the appointee will remain with
CSU for an appropriate interval after the support has ended.
Please complete this form and return it at least eight weeks in advance of the start of the
program for which you are applying. Completed forms should be sent to: CCSU-SUOAF MRMC
Name:
Department:
Title/Rank:
Date of hire:
Email:
Phone #:
1. Please describe the reasons for which you seek financial assistance. Please attach a
program description or brochure if available.
Name of Institution of Organization you wish to attend:
Anticipated dates of attendance:
Itemized Costs:
_____________________________________________
_____________________________________________
____________________________________________
_____________________________________________
2. Please indicate how the training, conference information, credentials or qualifications
sought will enhance your skills and/or advance your professional goals. Attach a separate
sheet if necessary.
3. Please indicate the total amount of financial assistance for which you are applying.
$________________
Equal Opportunity Employer and Educator
4. Please indicate any other sources of financial support you are seeking and the amount
requested.
_______________________________________________________
$_____________
_______________________________________________________
$_____________
I understand that a condition of receipt of funds pursuant to article 3.2 of the CSU-SUOAF
collective bargaining agreement is that I make a commitment to remain at CCSU for a mutually
agreed period of time after the financial support has ended.
Signature of Applicant: _________________________
Date: ____________________
Recommendation of the CCSU-SUOAF AFSCME MRMC:
Recommended
Not Recommended
_____________
_____________
Chair’s signature:
_____________________________ Date: ______________________
University Action:
Approved:
________________
Disapproved: __________________
Chief Diversity Officer’s Signature :__________________________
Comments:
Date:____________