Orange County Community College
Faculty/Staff Development Committee
115 South Street
Middletown, New York 10940
FSDC
Professional
Development Report
FSDC Professional Development Report
Department: ________________________________ __________________________
Name:
Home address: _________________________________________________________________
____________________________________________________ _____________
(Requested by Payroll Department)
e-mail (if used ) Phone number ___________________ ___________________________
course
.
The FSDC has approved your
________________ from the .
mini-grant special project Harriman grant
application in the amount of $
The following steps should be followed when requesting reimbursement from the general fund.
Send two copies of each of the following to the FSDC Chair:
1. This completed form
2. An updated attached FSDC expense report with the final or actual expenses noted
3. Your official receipts or proof of payment
4. Confirmation of course completion (e.g. confirmation from OCCC Academic Services, final grade, Harriman purchase confirmation)
Date of activity ______________________________________________
Location
Please give a brief description and your evaluation of this activity; or Harriman Purchase:
____________________________________ Date:Signature:
FSDC Professional Development Report Revised May 2010 Page 1 of 2
_______________ .
