Professional Development Funding Requests
(2015-2016) – FINAL Round
INSTRUCTIONS AND TIMELINE
The Professional Development Committee is accepting funding requests from all Chabot faculty,
classified staff, and administrators for the 2015-16 academic year to support professional evaluation
goals.
To request funding, please use the attached Professional Development Funding Request Form. This
second round of requests will be accepted until Friday, March 18, 2016. Your completed Request Form
must be submitted to any of the Professional Development co-chairs: Katrin Field, Ken Grace, Maria
Ochoa, or Rachael Tupper-Eoff. Prior to filling out the funding request form, please speak with your
Dean/Area Manager about other funding sources within your division or area.
This is the FINAL opportunity to request funding for the 2015-2016 year.
Requests will be evaluated using the rubric provided on our website, and all applicants for this second
round will be notified of the status of their request by March 25, 2016.
PROFESSIONAL EVALUATION GOALS
If you have questions about what your student learning goals or professional evaluation goals are,
please speak with your immediate supervisor.
Evaluation forms can be found on the HR website, http://www.clpccd.org/HR/HRGovForms.php;
additional evaluation information can be found in the faculty and classified
contracts, http://www.clpccd.org/HR/HRContactsandSalarySchedules.php.
FUNDING FOR 2015-16
All funds from the Professional Development Committee will be received via reimbursement; applicants
are required to complete all necessary paperwork and provide required documents in adherence to the
Professional Development, Chabot College, and CLPCCD time lines and policies.
The Professional Development Committee will make every effort to fund applicants in the full amount
requested (up to $500.00) However, circumstances may result in some applicants receiving partial
funding of the amount requested from the Professional Development Committee. In these cases, the
reason for partial funding will be explained to the applicant.
These funds must be spent by June 30, 2016, so we are only able to fund requests for activities that will
be completed prior to the June 30th fiscal year close.
**NOTE: due to compatibility issues, do not use Google Chrome to open or download this form.**
CHABOT COLLEGE
Professional Development Funding Request Form • 2015-2016
☐ Yes, I have spoken with my area Dean/Area Manager about all possible funding sources for
this request (Basic Skills, Equity, SSSP, division funds, etc.)
APPLICANTS
List all persons involved in this professional development opportunity. Include name and position for
each individual. Identify the primary contact person: _____________________________________
Other participants: ________________________________________________________________
_______________________________________________________________________________
TECHNICAL INFORMATION
Name of professional development opportunity _______________________________________
Location of professional development opportunity _____________________________________
Date(s) of occurrence ____________________ Amount Needed (per person) _________________
I am aware that all Professional Development funds will be received via reimbursement: ☐ Yes
Amount Requested from Professional Development Committee:
Per person: ________________ ($500 max.)
Did you request funds in Program Review?
☐ Yes
Total Amount: ________________
☐ No
Did you request funding from other sources (ex: division, Basic Skills, SSSP, Equity, etc.)?
If yes, where? _________________________________________
☐ Yes
☐ No
Were any funds allocated? ☐ Yes; amount: $____________ ☐ No
Write a brief summary of the professional development opportunity, including use of funds. Please
consider the criteria from the Evaluation Rubric in your response. Attach additional pages if necessary.
CONNECTION TO EVALUATION: Professional development must be tied to evaluative
measures specific to job functions. Please use the box on the second page to answer the following
question.
☐ Faculty: How does this activity support your student learning goals/professional evaluation goals?
☐ Classified: How does this activity support your professional evaluation goals?
☐ Administrators: How does this activity support your professional evaluation goals?
FINAL (Third Round) 3/07/16
Connection to Evaluation (cont’d)
IMPACT ON PROFESSIONAL GROWTH: Best practices for professional development and
growth involve collaboration and sustained support for the integration of new learning into
practice. Please answer the questions in the space provided below.
Completion of the Professional Development Activity Report is required for reimbursement. How else
do you plan to integrate the knowledge you’ve acquired through this opportunity in your daily work?
With whom on campus will you share this experience and knowledge? (check all that apply)
☐ Campus Presentation (Flex Day, presentation to students, etc.)
☐ Division/discipline meeting
☐ Written report to post on Professional Development website
☐ Community presentation (rotary, community engagement, etc.)
☐ Publish (please indicate publication: ______________________________ )
☐ Other: _______________________________________________________
BUDGET: Please provide a budget for this activity, including a breakdown of expenses. If you are
requesting to attend a conference, you also need to fill out and attach the Conference Leave: Request
Form (http://www.clpccd.org/business/documents/ConferenceLeaveRequest.pdf). You may use the
lines below or submit your budget report on a separate sheet (be sure to attach!).
Item(s)
Cost
_____________________________________________
___________________
_____________________________________________
___________________
_____________________________________________
___________________
_____________________________________________
___________________
I, _____________________, agree that by accepting Chabot College Professional Development funds
that I will apply the funds as specified in this application, integrate the knowledge I have acquired
through this opportunity in my daily work, and share this experience and knowledge with the
appropriate groups on campus as indicated above.
______________________________________
__________________________________
Print Name
Signature
_______________________
Date
FINAL (Third Round) 3/07/16