Fill - Free fillable Professional Development Abs Admin.-request (Central Oregon Community College) PDF form

CentralOregonCommunityCollege

RequestforProfessionalDevelopmentFunds/Reimbursement

Administrative/AdultBasicSkills



Updated5/2015

\\FS2\Dept\Human_Res\WP\FORMS\ProfessionalDevelopment

Instructions:Pleasefilloutformcompletely,printandattachallreceipts,classschedulesandtranscriptstotherequest.Send

RequesttoHumanResourcesforprocessing.Seebelowforeligibleexpenses

Name:___________________________ _____________ DateRequested:_______________

Department:__________________________________ COCCIDNumber:_______________

AdministrativeorABS?__________________________ Full‐time/part‐time:_____________

TelephoneExt.:________________________________ DateofHire:___________________

College/University:_____________________________ DegreePursued:________________



Pleasegiveadetailedaccounting/breakdownoftotalcostsforthisreimbursementrequest:

Totalamountapplyingfor:______________________

Priorfundsapprovedthisfiscalyear(July1‐June30):______________________

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Breakdownofexpenses:

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Tuition:________________

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Books:___________________

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Travel/Lodging:________________

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Other:___________________

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CheckRequesttofiscalservices:

Makecheckpayableto:______________________________________________________________

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StreetAddressorOfficeLocation:______________________________________________________

______________________________________________________

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City:_____________________________

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State:__________________

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Zip:________________

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SignatureofApplicant:_____________________________________________________________



SignatureofSupervisor:_____________________________________________________________

(pleaseprintandsign)

***********************************************************************************

ForHRUseOnly:

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ApplicationApproved:___________________ ApplicationDenied:_____________________

AmountApproved:____________________ Accounttocharge(s):

___________________

____________________

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AuthorizedSignatureorbudgetadministrator:__________________________________________

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Professional Development Abs Admin.-request (Central Oregon Community College)

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