Request to Attend Professional Meetings, Conferences, Workshops
Copy and use a separate page for each meeting, conference or training
Name:
County:
Program Area:
Meeting, Conference or Training:
Approximate cost to attend:
Date(s):
Registration $
Title:
Mileage $
Location:
Meals $
Coordinator of Training
Lodging $
Misc. $
Matching Funds, if available
(grants, gifts, awards)
$
(matching funds)
Total Cost: $
$
Total Cost for District:
What role will you have at this
event?
How will you put the
information/training received at
this event to work in your county
educational program? Please be
specific about any classes or
educational efforts which will be
conducted as a result of this
event.
Have you attended this event in the past 3 years? Yes_____
No_____
Fill out and return (mail or fax) to the District Office
PDC Comments
DEH Comments