2016-17 Pre-approval Request Form

CRITERIA FOR TITLE II APPROVAL
Reasonable / ·  Does this PD align to your School Improvement Plan and PD Goals?
·  Have you planned for a sequenced and sustained learning for the teacher/staff member(s) throughout the year after attending this PD?
Necessary/Allowable / ·  Why is this PD necessary?
·  Is this PD supplemental to your core program rather than supplant.
Allocable / ·  Have you checked to make sure there are enough funds to provide this PD?
·  Does this PD provide the best cost benefit to result in the greatest impact for staff and students?

CRITERIA FOR TITLE II APPROVAL: Before completing the Preapproval Request Form, please review the criteria below and be prepared to provide evidence.

Pre-approval requests must be submitted Uat least 4-6 WEEKS prior to desired payment for which a school is requesting funding. Out of State travel requests require 8 weeks.

Complete all information listed below; if you have questions regarding required information contact the Professional Development and Funded Programs Office at 612-668-0690.

ATTACHMENTS (check all those attached) (u= REQUIRED FOR PREAPPROVAL):

q  Conference/Workshop Description (must include schedule w/dates & times if travel is requested)u

q  Registration Form (including ALL the information re: workshop costs, location, dates/times, remit to address, etc.)u Important that the school does not register the participants.

q  ORIGINAL Non-Public Request for Payment Form

q  W-9 q Vendor Information and Payment Form q Vendor Registration Form (if not already on file)

q  Professional Development Proposal Form (for professional development proposals that are UnotU conferences/workshops)u

q  Consultant resume (including contact information)u

NONPUBLIC SCHOOL
ACTIVITY/CONFERENCE TITLE
NAME OF SPONSORING ORGANIZATION
LOCATION U(city, state)U** / EVENT DATE(S) / TRAVEL START DATE** / TRAVEL END DATE**
FUNDING SOURCE
(check those that apply): / qTitle I_A qTitle I_FI qTitle I_LEA qTitle II qTitle III
PARTICIPANTS**If more than two participants are attending the same conference, Uattach a listU of all the participant names with specific title/job/grades/subject taught / (Legal) Name: / (Legal) Name:
Specific Title/Job/Grades/Subject Taught: / Specific Title/Job/Grades/Subject Taught:

**UIf travel is requested, you must complete a separate Pre-Approval Request Form for each individualU.

Check All
That Apply: / Cost
(if you do not know the actual cost at time of request, leave item UblankU) / Details / Comment/
Info. / MPS Use Only
Approved / Denied / Date
Paid / Comment
qregistration fee / $ / CEU’s required
qconsultation fee / $
qairline flight / $
qairline baggage fee / $
qhotel / $ / # of nights:
qtaxi/shuttle
to & from destination airport ONLY / $
qmileage (current IRS rate) / $ / total miles:
qmeal per diem / $
qPD materials Upurchased
Uat conference / $
qstipends / rate per hour
$ / total hours:
qother – describe: / $

Principal Signature Date

MPS Signature Date

2016-17