CLASSIFIED PROFESSIONAL DEVELOPMENT GRANT APPLICATION
DIRECTIONS FOR COMPLETION: See “Grant Guidelines and Procedures”. Please fill
out the application using the tab key to guide you as you go. Entries can be made in the
gray boxes and the boxes checked with the mouse or spacebar. The page will expand to
accept your computer-keyed answers. You may also print and fill this form out by hand
or typewriter. All fields must be filled in.
SECTION A: EMPLOYEE INFORMATION
First Name:
Last Name:
Mailstop:
Phone:
Social
Security# :
Position Title:
Campus:
Length of
Employment in the
District.
years
months
SECTION B: ACTIVITY DESCRIPTION
(Attach copies of brochures, registration forms, pertinent information.)
1.
Title of activity:
2.
Sponsored by:
3.
Please indicate if this is a:
4.
Location of Event:
5.
Beginning Date of Event:
Ends:
6.
Beginning Hours:
Ends:
7.
Day(s), check all that apply:
8.
How will this activity enhance your job, career development, or attitude on the job?
Class
M
Seminar
T
Retreat
W
Th
Conference
F
Workshop
Sa
Su
other, specify here
Credits Earned:
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SECTION C: BUDGET INFORMATION
(Attach all relevant documents. If a personal check is requested, receipts of registration and other expenses
must be included.)
Registration Fee:
$
Travel:
$
$
$
Other Expenses, please itemize:
$
Total Expenses:
$
yes
no
Have you asked your division/
department for funds for this
activity?
If yes how much will they contribute? $
Total Grant Request
$
In what form do you want your award?
Budget Name:
Personal Check
Department Budget
Budget Number:
I understand that in order to be considered for this grant the information I have provided must be verified,
and that misleading or false answers may cause disqualification of my application.
Signature
Date
All activities attended during work hours must have your supervisor's approval. Please have your supervisor
sign the following statement if this activity is during work hours.
Supervisor Approval: I approve of the above named classified employee attending this activity which occurs
during work hours.
Signature
Date
CDAC Approval:
Amount Approved:
Signature
Date
Human Resources Approval:
Amount Approved:
Vice Chancellor Signature
Date
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