FY16 ProfDevApplicationForm

advertisement

UIS Civil Service

Application for Funding for

Professional Development

FY 2016

application. Please type in the appropriate field information. Handwritten forms will not be accepted. Please submit completed applications to Bobbie Fults at [email protected]

or MS UHB 3100. Questions? Contact Bobbie Fults at [email protected]

.

The application deadline is 5:00 p.m. on

Friday, October 16, 2015

.

Name: __________________________________________________________________________________________

UIS Email Address: _____________________

Title/Description of Activity, course, publication, certification, etc:

___________________________________________________________________________________

Dates of Activity: ___________________________________________________________________________________

Please attach a detailed statement regarding the relevance of this activity to your profession, your professional

development at UIS and/or your unit: (250 words minimum, Please include event/activity website address if applicable.)

Please attach your supervisor’s Statement regarding the relevance of this activity for the employee and unit

(optional):

Total cost of activity: (approximate if necessary)

Cost share from home unit: (if any)

Total amount of CSAC Professional Development request:

$____________

$____________

$____________

This will be done on my own personal time:

Yes No

Will you be able to participate in this activity without Professional Development Funding?

Yes No

Name of Unit’s Fiscal Officer: (required) _________________________________________________________________

Unit Fiscal Officer’s Email Address:

_____________

Travel Budget

A detailed budget must be included for travel award requests. For specific and official travel reimbursement and per diem

information, go to http://www.obfs.uillinois.edu/ .

Conference Registration

Hotel

Number of nights ______

Rate per night $ ________

Airfare

Taxes _____%

Mileage – Personal Car

_____ miles x $0.565

Date and Time you left Springfield

Date and Time you will return to Springfield

Taxis / Public Transportation

Per Diem

In-State ____breakfast x $5.50

In-State ____ lunch x 5.50

In-State ____dinner x $17.00

Out-of-State ____breakfast x $6.50

Out-of-State ____ lunch x $6.50

Out-of-State ____dinner x $19.00

Misc Expenses: ______________________

Total Expenses

Unit Contribution

Personal Contribution

$__________

$__________

$__________

$__________

__________

$__________

$__________

$__________

$__________

$__________

$__________

CSAC Professional Development Funding Request

Hours worked in excess of full time hours *

Notes/Comments:

$________

__________

*Guidelines:

All UIS Civil Service status employees are eligible for funds.

In most cases, maximum funding is $1000 per person. However, if you apply for travel to a conference

• for which the registration fee is $600 or greater, you may request up to $1200 from this program.

Reimbursements or charges must occur no later than June 30 th

Funding will be reimbursed to a state account in the individual’s unit. Detailed instructions will be included with the award announcements.

*For non-exempt employees, compensable hours worked in excess of full-time will only be treated as compensatory time No overtime pay is allowed. Requires Supervisor Pre-Approval

Announcements on funding will be made no later than November 13, 2015

Certification

I certify that the information provided above is correct. I understand that university regulations, including travel regulations, will apply to any funding awarded.

Applicant Signature: (required) ____________________________ ____________ Date:

Supervisor’s signature: (required) __________________________ ______ Date:

Amount of CSAC Funding Approved $

Authorization:

CSAC

Download