Fillable Exempt Employee Long-term Prof Dev Proposal Leave of Absence Form3

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Exempt Employee Long-term Prof Dev Proposal Leave of Absence Form3

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Exempt Employee Long-Term Professional
Development Proposal - PART 1
PART I: APPROVAL
DEPARTMENT
TITLE
COCC ID
#
NAME (Last, First, Middle Initial) DATE PREPARED
The purpose of a Long-Term Professional Development Leave for an exempt employee is for the employee to
participate in opportunities to grow and learn in a professional capacity. Part I – Approval must be submitted
according to section 8 of the Administrative Handbook and at least 30 days prior to initiating professional
development or may be required six months prior for long-term absences or work reassignment. You will need to
submit a request annually for review if anticipated continuting education extends beyond one year. Prior
year summaries or progress reports must be included in any additional requests.
2. Please give a brief Professional Development Abstract including completion goals:
PERIOD OF
LEAVE
BEGIN DATE
END DATE
1. Professional Development Outcomes: (must meet both of the following: 1) contribute to the professional expertise of
the administrator for professional growth and/or goals for completion identified in the employee’s Annual Evaluation; and
2) support COCC’s Strategic Plan Themes and Objectives)
YEARS OF
CONTINUOUS SERVICE
3. Proposed plan of activities (note how activities are linked to outcomes noted above):
PART I: APPROVAL
4. Timeline (include number of terms requested and projected completion date):
5. Identify work schedule modifications and plans for addressing these modifications:
6.
Attach to your proposal:
1. Letter of Support from the your immediate supervisor
2.
Letter of Support from appropriate Executive Level member identifying budget requests to support the
Professional Development, including any work-related changes impacting the department.
A
pproved
Not Approved
REV 08/2019
Recompensable Items (travel, lodging, books, materials, meals, and tuition) up to $1200 for 1.0 FTE, prorated for less
than 1.0 FTE but more than .5 FTE (please attach original receipts) If you need more room, attach page to back of
Approval.:
Item Cost Approved
Professional development funding will support exempt employees working .5 FTE or more with at least five (5)
consecutive years of service at COCC on and exempt-type contract in one or more exempt positions.
Human Resources Review
Long-Term Professional Development Proposal
Supervisor Signature
DATE
DEPARTMENTAL AND BUDGET REVIEW
EMPLOYEE SIGNATURE
DATE
In accepting Long-Term Professional Development, I agree to furnish a debrief (see PART 2) summarizing accomplishments and to adhere to all terms and conditions set forth in Section 8 of
the Exempt and Confidential Supervisory Handbook, including repayment. Upon approval, employee must complete the Exempt Employee Professional Development Memorandum of
Agreement (MOA).
Budget Review
Personnel Cost $
Date
Signature of Director of Human Resources or Designee
Copy to:
•Supervisor
•Employee
•Employee File
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Exempt Employee Long-term Prof Dev Proposal Leave of Absence Form3

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Completed 8 February 2020

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