D epartment of
EDUCATIONAL STUDIES
Faculty Handbook Appendices
This document contains information and operating procedures for Department Faculty and Instructional Academic Staff.
DES Faculty Approved: May 1, 2012
Department of Educational Studies | A Faculty Handbook
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Department of Educational Studies
Faculty Handbook Appendices
Administrative Responsibilities
Campus Absence Form
Chair Evaluation Form
Course Delivery Model Change Request Form
WI DPI License Codes
Majors and Minors (certifiable)
Meeting Minute Template
Praxis II Licensure-Number Chart
Student Evaluation (SEI) Form
Syllabus Template
Travel Funds Request Form
Department of Educational Studies | A Faculty Handbook
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Administrative Responsibilities
SOE Director
Promotes the College on
campus and in the
community
Promotes the School of
Education on campus and in
the community
Ensures that policies are
followed and makes
recommendations to the
Provost on faculty hiring,
promotion, and tenure
Responsible for the overall
integrity of Professional
Education Programs
Oversees recruitment, hiring,
and mentoring of a diverse
faculty
Supervises the certification
officer (CLS Dean)
Insures that faculty have
adequate resources to support
teaching and scholarship
Insures that SOE has
sufficient facilities, equipment
and budgetary resources to
fulfill its mission to offer
quality programs.
Insures that SOE has
adequate budgetary resources
to support field experiences
of teacher candidates and
professional development for
faculty and PK-12 teachers
(CLS Dean)
Provides adequate
classroom, laboratory,
office, and workspace
which have adequate
technology, equipment,
Conducts regular
programmatic evaluations and
prepares final reports for
Department of Public
Instruction accreditation
review.
Oversees governance of the
Professional Education
Unit
Coordinates professional
preparation across all
departments housing
Professional Education
Programs
Supervises the Director of the
Office of Field Experience.
Leads programmatic
initiatives which include
conceptualizing program
vision, designing and
monitoring an assessment
system and professional
development activities
Monitors certification
programs to ensure that all
programs are aligned with
conceptual framework and
state and national standards
DES Chair
Program Director
Promotes the Department on
campus and in the community
Promotes designated
program on campus and
in the community
Responsible for course
registration and scheduling in
consultation with faculty
Establishes faculty teaching
assignments and other
workload responsibilities as
determined by programmatic
needs and as governed by
Department by-laws
Reviews and endorses
curricular changes,
faculty projects, and grant
applications
Implements the
curriculum which includes
receiving and responding to
concerns about curriculum and
acting on substitution and
waiver requests
Prepares the annual
departmental budget for
travel, equipment, and other
expenses
Makes assignments of
offices, classrooms, and other
work areas; obtains other
facilities when needed; and
requests maintenance for
repairs for equipment, offices,
classrooms, and other
Works with DES chair to
establish program faculty
workload
Serves a communication
liaison for advising DES
chair on registration,
advising, assessment,
admission, scheduling, and
instructional
needs of the program
Creates, promotes, and
plans program curricular
changes with program
faculty and DES chair
Assists DES chair to
ensure curriculum
delivery
Serves as a
communication liaison
between DES chair,
program faculty, and
university community
Establishes schedule of
program meetings
Conveys to DES chair
personnel needs of
program including
staffing, graduate
assistant, and staff needs
Department of Educational Studies | A Faculty Handbook
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and supplies needed to
fulfill the institutional
mission
Approves and renders
decisions on equitable
workload policies to
insure that all faculty who
teach in initial and advanced
programs have
the time and resources to
accommodate teaching,
advising, research and
scholarship, administration,
committee
work, supervision and
other institutional and
community service
activities
Reviews and renders decisions
on all items related to
professional education policy
including: admission and exit
requirements, program
enrollment management, and
goals for professional
education.
Reviews and renders
decisions on programmatic
changes which alter
professional sequence of
studies for programs leading
to certification to serve as a
Birth to Twenty-one
professional.
work areas.
serves on SOEL Team
Establishes a schedule of
department meetings and
presides at same.
Leads programmatic
initiatives in consultation
with DES chair and SOE
Director
Conveys to the appropriate
administrative officer the
personnel needs of the
department for faculty and
academic staff, graduate
assistants, classified staff and
student help.
Monitors all departmental
search and screen activities for
compliance with UW-L
Affirmative Action hiring
procedures.
Receives and responds to
student questions, concerns,
and complaints regarding
courses, curriculum
requirements, faculty, and
grades.
Department of Educational Studies | A Faculty Handbook--Appendices
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University of Wisconsin-La Crosse
Department of Educational Studies
CAMPUS ABSENCE FORM
For protection of all concerned, this form should be filed (at least one week in advance of a campus absence) when any of the
following apply:
a. if some or all of the expense for the absence is to be paid with state funds
b. if some or all of the time of the campus absence falls within the person’s normal work day or week, Monday
through Friday
c. if a University vehicle is to be used for travel during the campus absence
d. if some or all of the reason for the campus absence is related to official business of the university
NAME ________________________________________________ Department: _____Educational Studies______
Purpose of Proposed Absence:
Duration of Absence (dates): _______________________________________________________________________
Location Information: (include hotel/conference site name, address, & phone number)
Course/Responsibility Coverage: (list each class/University responsibility, scheduled time, and what specific arrangements were
made to cover that responsibility)
University
Class/
Responsibility
Scheduled
Time
(day & time)
Coverage Arrangement
Original format
Proposed format
______ in person
______ online
______ blended
______ distance (Skype)
______ project
______ peer covers
______ in person
______ online
______ blended
______ distance (Skype)
______ project
______ peer covers
______ in person
______ online
______ blended
______ distance (Skype)
______ project
______ peer covers
______ in person
______ online
______ blended
______ distance (Skype)
______ project
______ peer covers
______ in person
______ online
______ blended
______ distance (Skype)
______ project
______ peer covers
______ in person
______ online
______ blended
______ distance (Skype)
______ project
______ peer covers
Did you also file a Travel Request form? _____ Yes
Additional Information
_____ No
_______________________________________________________________________________________________
Faculty/Instructional Academic Staff Signature
Date
Record of Action on Request: Approve _____ Disapprove _____
_______________________________________________________________________________________________
Signature of Department Chair
Date
If you wish to have information about this event included in Campus Kudos you may e-mail your information to connectx@uwlax.edu.
Department of Educational Studies | A Faculty Handbook--Appendices
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Department Chair Evaluation Form
Administrative Performance Evaluation
Name of the Person Being Evaluated: _
Title: Chair, Department of Educational Studies
Directions: Using the 5 point scale shown below, please evaluate the above named person in terms of each of the
following:
Excellent
Good
5
Average
4
Fair
3
Poor
2
Don't Know
1
0
(Please indicate ONE whole number per line--do not use 2/3, 4/5, etc.)
1. Leadership skill as displayed by ability to motivate faculty to perform effectively.
2. Maintains faculty morale by reducing, resolving or preventing conflicts.
3. Ability to establish and maintain effective working relationships with administrative and student assistants.
4. Ability to establish and maintain effective working relationships with faculty.
5. Ability to establish and maintain effective working relationships with UW-L administrators.
6. Willingness to provide assistance to faculty when consulted.
7. Makes clear to those affected on what basis decisions are made.
8. Is respected by colleagues.
9. Receptivity to new ideas.
10. Ability to allocate college/departmental resources so as to achieve the most effective use of resources.
11. Perceived as a person with integrity.
12. Perceived as a trustworthy person.
13. Effectiveness in following through with commitments
14. Fairness in giving faculty performance evaluations.
15. Treating faculty fairly in personnel matters.
16. Arranges effective and equitable allocation of faculty responsibilities.
17. Manages effective and efficient department meetings.
18. Makes decisions that are in the best interest of the department.
19. Ability to make decisions on the basis of the best information available.
20. Making effective personnel and other administrative decisions to maintain excellence of the University.
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21. Clear communication of ideas.
22. Clear communication of policies.
23. Openness to change, when necessary.
24. Being approachable on most topics and willing to hear them out.
25. Effectively manages the department’s office and staff.
26. Commitment to doing the best job possible.
27. Overall evaluation (use 10 point scale below)
Excellent
10
Good
9
8
Average
7
6
5
Fair
4
3
Poor
2
1
0
Comments: If you wish to include comments, please use the back of this page or attach a separate page of this form.
Department of Educational Studies | A Faculty Handbook--Appendices
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University of Wisconsin-La Crosse
Department of Educational Studies
COURSE DELIVERY MODEL CHANGE REQUEST FORM
NAME ____________________________________________ Semester: Fall _________ Spring ________
Course #: _______________________________________________________________________________
The Department Chair in collaboration with Department faculty designates the format of course delivery. Courses may
be offered in a traditional face-to-face, hybrid, or online delivery models. (Approved by Faculty Senate on April 15, 20
10). Changes to all course delivery models must be approved by the Department Chair at the outset of the semester or as
soon as an absence is known. Faculty and Instructional Staff cannot decide on an individual basis that a course or
individual course sessions can/will be delivered in an online or hybrid fashion to compensate for an absence.
Definitions of Course Delivery Models:
Online instruction = courses are those in which all, or nearly all, instruction is delivered over the Internet.
Blended instruction = require online learning as well as traditional in‐class instruction.
Distance (Skype) = utilize real time (synchronous) two‐way communication between instructor and student.
In person = synchronous instruction in the same physical classroom
(Approved by Faculty Senate on September 28, 2006)
Current Delivery Mode: (indicate % of time spent in each
delivery model)
Proposed Delivery Mode: (indicate % of time proposed in
each delivery model)
__________ in person
__________ online
__________ blended
__________ distance (Skype)
__________ in person
__________ online
__________ blended
__________ distance (Skype)
Rationale for delivery change:
________________________________________________________________________________________________
______
Faculty/Instructional Academic Staff Signature
Date
Record of Action on Request: Approve _____ Disapprove _____
________________________________________________________________________________________________
______
Department Chair Signature
Date
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Department of Public Instruction (DPI) Licensure Codes
The following is a list of PI34 certification codes for Wisconsin only. The codes listed represent certification
programs offered by UW-La Crosse. Some employers are advertising positions using older certification codes; if
you see codes other than those listed below and want to know if you could apply for the position, contact
Sandy Keller (608-785-8123) or keller.sand@uwlax.edu.
Early Childhood-Middle Childhood (EC-MC)
71-777*
*NOTE: “777” denotes all subject areas for EC-MC and MC-EA majors
Middle Childhood-Early Adolescence (MC-EA)
72-777*
Earth Science
72635
English (MC-EA majors)
72-300
ELS (MC-EA majors)
72-395
French (MC-EA majors)
72-355
General Science (MC-EA majors)
72-634
Geography (MC-EA majors)
72-715
German (MC-EA majors)
72-370
History (MC-EA majors)
72-725
Mathematics (MC-EA majors)
72-400
School Health (MC-EA majors)
72-910
Social Studies (MC-EA majors)
72-734
Spanish (MC-EA majors)
72-365
Special Education (MC-EA majors)
72-801
*NOTE: “777” denotes all subject areas for EC-MC and MC-EA majors
Early Adolescence (EA-A)
Biology (EA-A)
Broad field Science (EA-A)
Broad field Social Studies (EA-A)
Chemistry (EA-A)
Computer Science (EA-A)
Earth Science (EA-A)
Economics (EA-A)
English (EA-A)
ESL (EA-A)
French minor (EA-A)
Geography (EA-A)
German minor (EA-A)
History (EA-A)
Mathematics (EA-A)
Physics (EA-A)
Political Science (EA-A)
Psychology (EA-A)
Sociology (EA-A)
Spanish minor (EA-A)
Special Education (EA-A)
73-605
73-601
73-701
73-610
73-405
73-635
73-710
73-300
73-395
73-355
73-715
73-370
73-725
73-400
73-625
73-735
73-740
73-745
73-365
73-801
Department of Educational Studies | A Faculty Handbook--Appendices
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Early Childhood-Adolescence
Art (EC-A)
ESL minor (EC-A)
if major is French, German, or Spanish only
French (EC-A)
German (EC-A)
Music-Choral (EC-A)
Music-General (EC-A)
Music-Instrumental (EC-A)
Physical Education (EC-A)
Adaptive PE (EC-A)
School Health (EC-A)
Spanish (EC-A)
74-550
74-395
74-355
74-370
74-511
74-515
74-506
74-530
74-860
74-910
74-365
Department of Educational Studies | A Faculty Handbook--Appendices
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Teacher Education—Certifiable Majors and Minors
Early Childhood-Middle Childhood (EC-MC)
EC-MC majors are not required to complete a minor.
Middle Childhood-Early Adolescence (MC-EA) Licensure
Certifiable Minors:
Biology (24 cr)
Chemistry (26 cr)
Computer Science (20 cr)
Earth & Space Science (24 cr)
English (28 cr)
French (18 cr above FRE 202)
General Science (22-23 cr)
Geography (24 cr)
German (18 cr)
Health (52-64 cr)
History (24 cr)
Mathematics (22 cr)
Physics (22 cr)
Political Science (21 cr)
School Health Education (35 cr + 16 cr
Interdisciplinary requirements + St. Teaching)
Social Studies (25 cr)
Sociology (21 cr)
Spanish (18 cr)
Special Education (22 cr + St. Teaching)
Teaching English as a Second Language
(TESOL)(25 cr)
Early Childhood-Adolescence (EC-A) Licensure
Certifiable Majors:
Art
French
German
Music-General
Music-Choral
Music-Instrumental
Spanish
Early Adolescence-Adolescence (EA-A) Licensure
Certifiable Majors:
Biology
Broad field Science
Broad field Social Studies* (Option A or B
Chemistry
Computer Science
English
Mathematics
Physics
* The following content areas may be certified within the Broad field Social Studies Major with the completion of a second major or a minor:
Economics (minor only), Geography, History, Political Science, Psychology (minor only), Sociology
Certifiable Minors:
Biology (22 cr)
Chemistry (25 cr)
Computer Science (37 cr)
Earth Science (24 cr)
Economics (18 cr)
English (28 cr)
Teaching English as a Second Language
(TESOL)(25 cr)French (18 cr)
Geography (24 cr)
Note:
German (18 cr)
History (24 cr)
Mathematics (22 cr)
Physics (22 cr)
Political Science (21 cr)
Psychology (24 cr)
School Health Education (35 cr + 16 cr
Interdisciplinary requirements + St. Teaching)
Sociology (26 cr)
Spanish (18 cr)
Special Education (22 cr + St. Teaching)
Coaching Competitive Athletics is a certifiable concentration for MC-EA and EC-A candidates.
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Department Meeting Agenda/Minute Template
Regular Meeting of the Department of Educational Studies
Agenda
Date: December 6, 2013
Time: 11:00am – 12:30pm Location: 165 Morris Hall
Members Present: Ali, A., Angell, C. (Chair), Carlson, J., Chen, R., Epstein, A., Gander, B.,
Green, D., Harrington, J., Iwai, Y., Johnson, J., Kabashi, L., Love, M., Rogers, L., Rouse, D.,
Shanks, J., Thomas, M., Willhite, G., Yehle, A.
Members Absent:
Members Excused:.
Meeting: 12:00pm – 1:30pm
I.
II.
III.
IV.
V.
Approval of Minutes:
Reports: (see electronic reports)
Unfinished Business:
a.
New Business:
a.
Other items
a.
Next Meeting:
Date: __________ Time: __________ Location: __________
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Praxis II Test Number – Licensure Chart
What are the Praxis II: Subject Assessment Requirements?
The Wisconsin Department of Public Instruction in accordance with PI34, Wisconsin Administrative Code, requires
that all students completing a Wisconsin professional education (licensure) program take and pass the specific Praxis
II: Subject Assessments listed in the chart below that correspond to the license(s) they will be issued.
The following chart identifies the Praxis II tests required for certifications offered at UW-La Crosse. If you major is:
Early Childhood-Middle Childhood (EC-MC), need to take and pass test #0014.
Middle Childhood-Early Adolescence, need to take and pass test #0146.
o If your major is MC-EA and your minor (or second major) is in a foreign language (Spanish, French, or
German), TESOL, or health, need to take and pass the Praxis II content test required by the minor or
second major above for certification/licensure in the minor or second major, in addition to test #0146.
For example, if your major is MC-EA and your minor/second major is Spanish, take and pass
two Praxis tests, #0146 and #0191.
Minors in social studies, science, math, English, and special education do NOT need to take
another Praxis II content test; test #0146 is the only test required.
Early Adolescence-Adolescence (EA-A) and Early Childhood-Adolescence (EC-A) majors
(Broad Field Social Studies, Broad Field Science, Music, Art, etc.) see the chart below.
When do I need to take and pass the tests?
UW-La Crosse requires candidates to take and pass the Praxis II content tests which correspond to their
certification/licensure area(s) prior to the beginning of the student teaching semester.
Praxis II tests are both paper/pencil and computer-based tests administered at various times during the year.
Registration at least 30 days prior to each test date is required. Some tests are not offered each test date. Candidates
need to plan ahead to ensure successful completion of the Praxis II testing requirement prior to the beginning of the
student teaching semester. It is recommended to test early enough to allow for one or two retest sessions, if
necessary. Consult with your academic
advisor if you are unsure when to test. (See www.ets.org/praxis for registration times and locations.)
How do I prepare and register for tests?
Test dates, registration procedures, fees, and forms are listed on the Praxis website (www.ets.org/praxis) and are
also included in The Praxis Series Information Bulletin each academic year. When you register to test, designate
UW-L as a score recipient (code 1914). ETS offers test preparation materials for purchase to enhance performance
on the tests. The Alice Hagar Curriculum Center in Murphy Library also has many study guides on reserve. “Testat-a-Glance” documents on the ETS website provide test descriptions and content as well as sample questions with
answers.
Procedures:
1. Go to www.ets.org/praxis
2. Select “Wisconsin” in the state testing requirements box
3. Select the appropriate link for what you want (registration, test content information)
If you are unsure which test(s) you need to take, do not guess! Contact Sandy Keller, Assistant to the
Dean/Certification Officer, at 608-785-8123 or keller.sand@uwlax.edu for assistance.
Department of Educational Studies | A Faculty Handbook--Appendices
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Licensure Area
Test
Code
Early Childhood-Middle
Childhood (EC-MC) Regular
Education
Special Education
Cognitive disabilities
Cross-Categorical
Deaf or Hard of Hearing
Emotional Disturbance
Learning Disabilities
Visual Impairment
Middle Childhood-Early
Adolescence (MC-EA) Regular
Education
Art
English as a Second Language
10014
French
20173
German
20181
Health
Broad field Language Arts
English Literature Composition
Journalism
Speech
Communication
Mathematics (10-21)
20550
10041
Music
10113
Physical Education
Broad field Science
Biology
Chemistry
Earth and Space Science
Life & Environmental Science
Physics
Physical Science
Broad field Social Studies
Economics
Geography
History
Political Science & Citizenship
Psychology
Sociology
School Psychologist
Spanish
10091
10435
Test Name
Elementary Education: Content Knowledge
(calculator allowed)
20146
Qualify
ing
Score
147
146
Middle School: Content Knowledge (calculator
allowed)
20146
Middle School: Content Knowledge (calculator
allowed)
146
10133
20360
Art: Content Knowledge
English to Speakers of Other Languages
(contains listening section)
French: Content Knowledge (contains listening
section)
German: Content Knowledge (contains
listening section)
Health Education
English Language, Literature, Composition:
Content Knowledge
155
530
Mathematics: Content Knowledge (graphing
calculator required)
Music: Content Knowledge (contains listening
section)
Physical Education: Content Knowledge
General Science : Content Knowledge
(calculators prohibited)
135
10081
Social Studies: Content Knowledge
153
10400
10191
School Psychologist
Spanish: Content Knowledge (contains
listening section)
660
158
10061
156
153
610
160
150
150
154
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DEPARMENT OF EDUCAITONAL STUDIES
Student Evaluation of Instruction (SEI) Template
(Approved December 6, 2013)
UWL Required Items:
1. I was looking forward to taking this course.
2. The instructor was helpful to students.
3. The instructor was well prepared.
4. The instructor communicated the subject matter clearly.
5. I learned a great deal from this instructor.
6. Overall, this instructor was excellent.
7. What suggestions do you have to improve the course? [open-ended]
DES Revised Items:
Open-Ended
1. What could you have done to be a better learner?
2. What did the instructor do that most helped your learning?
Likert Scale items
3. The instructor engaged students in learning the course content.
4. The instructor treated me with respect.
5. The course objectives and assignments were clearly described in the course.
6. The instructor utilized a variety of learning materials, activities, and approaches.
7. The assignments contributed to my understanding of the course content.
8. I received constructive feedback (verbal, written, peer, etc.)on activities, assessments, and/or
assignments.
9. The course required both critical and creative thinking.
10. I am able to reflect on pedagogical approaches (e.g., instructional strategies, teaching methods/styles)
better as a result of this course.
11. I am better prepared to consider/support/teach diverse learners (including ability level, gender, race,
SES, modality) as a result of taking this course.
Open-Ended items
12. Please use this space to provide any additional comments.
Department of Educational Studies | A Faculty Handbook--Appendices
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DES Syllabus Template
Include the following on all syllabi for Professional Education Program courses.
1. Course Demographics:

Course title/number


Section
Credits

Semester/year
2. Instructor Demographics:

Instructor name

Office hours & location

Contact information (phone & email)
3. Conceptual framework:
Competencies for framework at http://www.uwlax.edu/soe/students/cf.html
4. Course Description: (could be taken from LX form or course catalog—WINGS)
5. Textbook information:
6. Objectives of the Course: (could be taken from LX)
7. Common Essential Learning Outcomes (ELOs): (could be taken from the program googledoc)
8. Common Course Assessment: (could be taken from the program googledoc)
9. Disability Statement:
“ Any student with a documented disability (e.g., physical, sensory, psychological, learning disability, AD/HD, or
are a current or prior military service member with wounded warrior status) who needs to arrange reasonable
academic accommodations must contact Disability Resource Services [165 Murphy Library, (608) 785-6900)] at
the beginning of the semester. In addition to registering with Disability Resource Services, it is the student’s
responsibility to discuss their needs with the instructor in a timely manner.”
10. Eagle Alert System:
“This class will be participating in the “Eagle Alert” system through WINGS. The Early Alert system is designed to
promote student success. If I notice that you are experiencing difficulties early in the semester (e.g., low assignment
scores or poor attendance), I may enter feedback into the program and you will receive an email indicating that
feedback has been left. I may also enter positive feedback encouraging you to think about additional opportunities.
You will be able to access the feedback through your student center in WINGS. I encourage you to meet with me
and use one or more of several helpful campus resources listed here http://www.uwlax.edu/studentsuccess/.”
11. Communication about Class Interruptions:
“In the event of a campus incident that impacts the availability of teaching spaces, any changes or cancellations will
Department of Educational Studies | A Faculty Handbook--Appendices
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be communicated to you via your university email. Depending on the incident, some or all of the information
might be posted on the UW-L home page.”
12. Academic Dishonesty Policy:
“Academic misconduct is a violation of the UW-L student honor code
(http://www.uwlax.edu/records/UGCat/Regulations/Disciplinary.htm). Academic misconduct is unacceptable. All
work handed in for this class must be the student’s own individual work. Plagiarism or cheating in any form may
result in failure of the assignment or exam, failure of the course, and may include harsher sanctions. Refer to the
Eagle Eye (http://www.uwlax.edu/StudentLife/academic_misconduct.htm#14.03) for a detailed definition of
academic misconduct. For helpful information on how to avoid plagiarism, go to:
http://libguides.uwlax.edu/content/php?pid=363671. You may also visit the Student Life Office if you have
questions about plagiarism or cheating incidents. I encourage you to discuss any concerns regarding plagiarism or
cheating with me directly and well before any assignments are handed in for grading. Failure to understand what
constitutes plagiarism or cheating is not a valid excuse for engaging in academic misconduct.”
13. Outline of Topics: (listing of topics to be covered matched with weeks of the semester)
14. Course Products/Activities:

Specific listing of course assignments/products/activities to be completed throughout the semester with due
dates with the following correlated to each assignment/product/activity.
o Course objectives (as listed above)
New InTASC standards addressed and assessed by each product/activity
Department of Educational Studies | A Faculty Handbook--Appendices
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University of Wisconsin-La Crosse
Department of Educational Studies
TRAVEL FUNDS REQUEST FORM
Name: _____________________________________________________________________________________
Date
___________________________________________________________________________________________
Organization and Event
____________________________________________
_____________________________________________
Date(s) of Travel
Location
Professional Involvement: (Documentation must be attached or forwarded as soon as possible.)
______a.
______b.
______c.
______d.
______e.
presentation of a paper, solo exhibition, or solo performance
service as an organization officer, board member, conference organizer, or juror
session chair, organizer, panelist, group exhibitor, or group performer
attendee
other (please explain) _______________________________________________
Impact Statement: Describe how the outcomes of the travel will impact teaching, research, or service activities and how the
information will be shared with others:
Cost Estimate: (Refer to Travel Guidelines, available from University Financial Administration on the web at:
http://www.uwlax.edu/travel/
Totals
Lodging:
Meals:
Luggage:
Conference registration:
Internet Charge:
Miscellaneous:
Number of nights _________at $ _________ per night
Number of days _________at $ _________ per day
Checked baggage fees _______ at $ _______ round trip
_____ at $_____ per day
(please itemize)
Total Estimated Amount
List other sources of support such as registration waiver, foundation grants, external grants, etc.
Total
$ _________
Support provided by Department: List other members of Department also attending
Total Amount Requested from DES
Total
$ _________
Record of Action on Request: Approve _____ Disapprove _____
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Department Chair Signature
Date
Department of Educational Studies | A Faculty Handbook--Appendices
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