Fillable Hello, and thank you for applying for Professional (Las Positas College)

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Hello, and thank you for applying for Professional (Las Positas College)

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3000 Campus Hill Drive, Livermore, CA 94551-7623 Tel: 925.424.1000 Fax: 925.443.0742
www.laspositascollege.edu
Hello, and thank you for applying for Professional Development funding for your activity.
The application packet is attached.
The PDC meets the second Monday of each month; the packets must be completed
and turned in to Rifka Several by 5:00 pm the first Monday of each month for committee
consideration. Out of state travel requires Chancellor approval, and out of country travel
requires board approval – please plan accordingly.
The current funding level per request is up to $500.
1. Activity Proposal Form: please have your dean or supervisor sign. For guidelines
on eligibility, please go to the Professional Development Committee website.
2. Itemization of Activity Expenses: please note that the mileage is to and from
LPC, not your home, and there is a maximum food allowance.
3. Conference Leave: Request Form: if you will require substitutes in your class(es),
please indicate it. This form must be signed by your dean or supervisor.
Attach supporting materials such as conference information and registration
forms.
4. Conference Leave: Expense Claim Form: this will be completed and turned in to
Business Services with the supporting information and original receipts after your
conference is over.
Please contact me with any questions, Rifka
Rifka Several – rseveral@laspositascollege.edu, 925-424-1014
Room 1681H
Professional Development Committee
1
Las Positas College
Professional
Development
Activity Proposal Form
Fill out this form completely and submit it along with all supporting documents to
the Professional Development Coordinator or their Administrative Assistant by the
first Monday of each month by 5:00 p.m. Incomplete forms will be returned.
Full-Time Check One
1. Proposer Name:
Faculty Classified Administrative
Part-Time*
Proposer Name: Faculty Classified
# of yrs. at LPC: Current workload: %
Location:
2. Activity Title:
3. Sponsoring Organization:
4. Work Group
to
Benefit:
5. Proposed Date(s):
6. Total Cost
of
the
Proposed Activity: $
**To view the current level of available institutional funding please check the PDC website here.
Please note that you may not apply for both PDC funds and other grant/initiative funding
simultaneously.
7.
Signature
of
Dean or Immediate Supervisor:
*(signature verifies that part-time staff applying for Professional Development funding meets the minimum requirements
of both a 40% workload and 2 consecutive years with LPC.)
Box
area
for
Professional
Development
Committee
only.
Please
do not write in this
space.
ACT. REQ. #:
PROF DEVELOPMENT PROJECT #:
Date:
Out of State:
YES NO
Amount of Funding Approved by Prof Development Committee: $
Committee Chair:
YES NO
Amendments or Reason for Disapproval:
2
Professional Development funds may be used according to AB 2558. Check the following AB
2558 categories that apply to your proposed activity and include a brief explanation (additional pages
may be attached as needed)
:
Improvement of teaching
Maintenance of current academic and technical knowledge and skills
In-service training for vocational education and employment preparation programs
Retraining to meet changing institutional needs.
Intersegmental exchange programs.
Development of innovations in instructional and administrative techniques and program effectiveness.
Computer and technological proficiency programs.
Courses and training implementing affirmative action and upward mobility programs
Other activities determined to be related to educational and professional development pursuant to criteria
established by the Board of Governors.
Brief description of how your activity meets the above AB2558 Guidelines:
3
Please fill out this page completely
. Your responses will assist the Professional Development
Committee with
evaluating your proposal for approval. (This is not the required one page summary)
1.
Describe how this activity ties in to your Program Review. Optional:
Identify sections/pages of your
Program Review that supports your staff development funding request.
2. Objectives and rationale of the proposed activity:
3. How will this proposed activity benefit the college?
4.
How do you plan to share what you have gained from the proposed activity with the
college
community, (i.e., present information at town meetings, division meetings, brown bag lunches,
workshops, etc.)?
4
Signature of Proposer:
Date:
Professional Development
Itemization of Activity Expenses
Activity Expenses
(Membership fees are NOT reimbursed)
Itemize all estimated costs below. RECEIPTS MUST BE SUBMITTED FOR ALL ITEMS WHEN YOU
REQUEST REIMBURSEMENT. REIMBURSEMENT MAXIMUM: Check the PDC Website for details.
1. Registration Fees:
$__________
2. Commercial Travel:
$__________
3. Accommodations:
cost/night _______ x # nights ____
= $__________
4. Mileage (to/from LPC):
Mileage ______ x $0.545/mile
= $__________
5. Food:
Up to $15 meal or $30/day
MAXIMUM
= $__________
(Does NOT include reimbursement for books, DVDs, CDs,
and other conference materials.)
$__________
7. Total Amount of Estimated Expenses:
$__________
CHABOT-LAS POSITAS COMMUNITY COLLEGE DISTRICT
Office of Business Services
Conference Leave: Request Form
Staff member(s): _______________________________________________________________
Conference title: _______________________________________________________________
(Note: please do not use abbreviations in form)
Date(s): ______________________________ Location: ____________________________
Sponsoring group: ______________________________________________________________
Purpose and contribution to Chabot-Las Positas Community College District?
(Please indicate any official position held which requires or makes desirable your attendance)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Estimated total cost of attendance, including transportation: $____________________________
List dates and classes requiring substitutes:
_________________________ _______________________________________________
_________________________
_______________________________________________
_________________________
_______________________________________________
Signature: __________________________________________________ Date: ____/____/____
Reimbursement for expenses for
conference and meeting attendance – see Administrative
Procedure (AP) 7400.
FOR OFFICE USE
Approval:
Division Dean signature: ______________________________________________ Date: ____/____/____
Vice Pres. or Vice Chancellor signature: __________________________________ Date: ____/____/____
President / Chancellor signature: ________________________________________ Date: ____/____/____
Cost is chargeable to division budget:
Yes : (labor distribution account) _____________-_____________-____________-______________
No
No cost to District
Maximum total reimbursement allowed:
Actual and necessary expenses
Limited to $________________
Routing: Original – Business office Copies: Academic Services
Division office
Staff member(s)
Reference:
Article 29E.3 – Faculty Collective Bargaining Agreement
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CHABOT-LAS POSITAS COMMUNITY COLLEGE DISTRICT
Office of Business Services
Conference Leave: Expense Claim Form
Name:
Address:
B $ $ $
/ / $ L $ $ $ $
D $ $ $
B $ $ $
/ / $ L $ $ $ $
D $ $ $
B $ $ $
/ / $ L $ $ $ $
D $ $ $
B $ $ $
/ / $ L $ $ $ $
D $ $ $
B $ $ $
/ / $ L $ $ $ $
D $ $ $
/ /
Claim forms must be received by the Business Office no later than the tenth day of the
month folowing the month in which the conference was attended.
Complete all appropriate items. If additional space is required, use additional forms. Refer to
Board Policy 4070 for procedure governing submission of claims.
1. Receipts must be attached for all expenses.
2. Reimbursements cannot be made for expenses itemized as tips or gratuities.
3. Conference expense claims must reflect expenses of the individual only.
4. Record conference mileage on this form.
Submit original and two copies to your Department Administrator for approval. Retain a copy for
your records and staple all receipts to the claim form.
(Last)
(First)
(MI)
Date
Meals
Registration
Conference title:
(Note: please do not use abbreviations in form)
$
Social security number / W #:
Date(s) Attended Conference:
Total Miles:
@
Other Expenses
¢ per mile
Location (City, State):
$
$
$
$
Daily Total
(Telephone, Taxi, Parking, Mass Transit, Etc.)
Miles
Traveled
Lodging
$
Total Claim:
$
Cost of Transportation:
Subtotal:
Less Advances:
Less P-Card:
$
$
-$
-$
Total Daily Expenses:
I certify that the above itemized claim represents actual and necessary expenses incurred by me while on authorized school business for
Public Transportation: From: _______________ To: _______________ Via: _______________ One-Way Two-Way
Expense Limit: $
APPROVED:
the purposes stated above.
Employee signature:
EXAMINED AND ALLOWED:
DISTRICT BUSINESS OFFICE:
DEPARTMENT ADMINISTRATOR:
CHARGED TO EXPENDITURE ACCOUNT NUMBER:
Date:
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Completed 4 September 2020

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