LAUREL COUNTY SCHOOLS

Out–of-District Professional Development/Travel Authorization

(This Form must be completed and submitted to the Principal two (2) weeks in advance of the PD/travel.)

Date Submitted ______Name of Attendee(s)______

School ______Principal/Supervisor______

Title of PD Activity: ______PD Activity Type: Conference ____ Co-op ____ or State sponsored ____ Other ____

Content Area of PD: ______Appropriate for Grades: K,1,2…All)______

Location:______Complete Address: ______

Description______

Facilitator/Contact: ______Facilitator/Contact Email: ______

Date(s)/Time:______# of PD hrs requested OR Stipend requested______

How does this PD relate to your PGP and/or CSIP? ______

______

(If applicable, complete for PDoutside Laurel County andout-of-state. Note N/A where appropriate.)

PD Registration Fee__$______X ______$______

(# of attendees)

Lodging __$______X ______X ______$______

(Ratepernight) (# ofnights) (# of attendees)

Meals__$______X ______X ______$______

(Costperday-max $36/day) (# ofdays) (# of attendees)

Personal Mileage______X __$______X ______$______

(# ofmiles) (current mileage (# of attendees)

reimbursement rate)

BOE Transportation requested: Yes ____ No ____ (Contact Paula Robbins, 862-4600)

Substitute X __$______X ______X ______$______

(if applicable) (est. $100/day) (# of days) (# of attendees)

Stipend ______X __$______X ______$______

(# of PD hours) ($15.00/hr) (# of attendees)

Other Expenses______Total Estimated Expenses __$______

Principal/Supervisor Signature ______Date Approved ______

Funding Source______(If no fund source listed, expenses will be deducted from Section 6funds.)

Email a copy of this form to Denise Griebel at the Garland Building.

Note:

1.This Formmustbereceivedtwo (2) weeksinadvanceof the PD for approval.

2.Principal should enter requested PD as an Activity Proposal in CIITS EDS PD if not already listed.

  1. Teacher should be notified of PD approval and to register in CIITS EDS PD Module.

3.Approved Formwill serve as documentation to the finance officetoadvanceregistration/lodgingfees,reimbursetravelexpenses, etc.

  1. Send a copy of the Form to Denise Griebel at the Garland Building.

4.If applicable, atravelexpense voucher should be submitted uponcompletionoftravel.(Attach/sign applicable receipts)