Fillable Orange County FSDC Professional Development Report

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Orange County FSDC Professional Development Report

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The Orange County FSDC Professional Development Report form is 2 pages long and contains:

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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
_______________ .
Print Form
Date of Application: Ext. _____________________ ___________ _____________ Applicant Name:
Dept / Area: _______________________________________ Date of coursework: _____________*
Estimated expenses are to be submitted with the application to the committee. Actual expenses are
to be completed after the event in order to get final payment.
Comments
Final Expenses
I. Coursework
A. Tuition
B.
Fees
II. Harriman Grant
Total expenses
Subtract amount paid by
other sources; specify
Dept., Area, Grant, Etc.
Total Actual Amount:
*Please use separate application and expense report for each course.
FSDC Actual Expense Report
FSDC Professional Development Report Revised May 2010 Page 2 of 2
A. Software
B. Equipment
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Orange County FSDC Professional Development Report

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Completed 16 February 2020

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