M State Campus Visit - Funding Request
Concurrent Instructor Information
Name: ______________________________________ High School:_____________________________________
Phone Number: _______________________________ Email: _________________________________________
Funding Request Information
Concurrent Course Name: ______________________________________________________________________
Number of Students: _________ Date of Visit: _______________ Amount Requesting: ____________________
M State Campus Visiting: Detroit Lakes Fergus Falls Moorhead Wadena
Reason for Funding Request (please provide details for the visit and what the funding will cover):
Instructor Signature: ____________________________________________________ Date: _________________
Scan and email completed form to concurrent@minnesota.edu
NOTE: If funding is approved, invoices must be sent to M State no later than June 1 to ensure reimbursement.
Once the completed form has been received, the CEP team will respond with approval, denial, or request for more information.
For office use only
Approved Denied Pending More Information
K12 Collaboration Manager Signature: _________________________________________________ Date: ____________________
Cost Center:_____________________ Marketplace Requisition Number:______________________
CONCURRENT ENROLLMENT PROGRAM www.minnesota.edu/concurrent
