Kellogg Community College Faculty Professional Development Program

APPLICATION FORM Sept. 2009

NAME______Date Submitted______

Department/area______

Description of your request:

a.  Date of activity:______

b.  Name of activity:______

c.  Name of sponsoring organization:______

d.  If you think it would be helpful to the committee, attach a copy of the activity flyer.

How is this request of value to your professional development? Please be clear about how it would affect your courses and/or your professional skills. (see guidelines 4a-d on other side)

Total estimated cost of your request (from other side)______

Review Committee Recommendation: APPROVED______NOT APPROVED______

Monetary Limits (if any)______

Signature______Date______

(chair of Professional Development Committee)

REMEMBER: approval of the funds for this activity does NOT mean you have approval to travel. You must still clear that with your supervisor (s) and fill out the appropriate travel forms.

Please make sure you fill out the detail on the other side of this form and sign it in the space provided.

Detail your costs. Fill in only those areas that are appropriate to your requested activity:

1. Travel (mileage, transportation) ______

2. Lodging ______

3. Meals ______www.gsa.gov (per Diem, without

incidentals, for your city)

4. Registration Fees ______

5. Misc: Parking, taxi, etc ______

(Describe here:)

TOTAL ESTIMATED COST ______(please transfer this amount to other side)

Criteria from the KFA Guidelines – approved and revised January 2001

  1. The following criteria shall be used by the Review Committee when making decisions regarding the distribution of the “pool:”
  1. All requests shall explain, in sufficient detail, the funds necessary to implement the request.
  2. All requests must be of value to the professional development of the individual and to the college. Value may be defined as any one or more of the following: value to existing or future courses, curriculums, programs, school activities, and/or student services that the faculty member is involved in—value in terms of the person’s Professional Growth Plan—value in terms of cognitive skills and/or occupational skills to be acquired by the faculty member—value in terms of credentialing—value in terms of professional recognition through presentations or awards.
  3. Requests shall not be submitted for items that are normally funded through another funding source. In addition, occupational area faculty members should check to see if Perkins Funds and/or Fastrack Funds are available for CEUS and credentialing sure and indicate on your request if you are a presenter at a conference since your registration will be paid from another budget source.

d. A brief, one page, summary of the approved activity shall be submitted to the Review Committee upon completion of the activity if requested by the committee.

It is explicitly understood that I will refund any unexpended funds if I receive an advance and/or return any portion designated for a purpose that I do not fulfill:

Your signature______Date______