Page 1 of 2 Revised 10/02/2013
This form must be submitted to Human Resources by the 3
rd
Friday of the month
CERRITOS COMMUNITY COLLEGE DISTRICT
REQUEST FOR PROFESSIONAL GROWTH PROGRAM
CLASSIFIED BARGAINING UNIT EMPLOYEES
(Supply a copy of the brochure, agenda or program of the conference, workshop, seminar, etc., or specific titles and descriptions of each course.)
Please describe how this activity is related to your current job responsibilities and/or the manner in which the proposed coursework
will broaden your opportunity for promotion within the service of the District. If the course work is part of a degree program, also
include the proposed degree and the major:
Conventions, Conferences, etc.
Cerritos College Courses*
Registration Fees/
Tuition
Registration Fees/
Tuition
*Cerritos College Coursework List:
I certify that this is a reasonable estimate of expenses. If this request is approved, I agree to submit ALL original receipts to the
Office of Human Resource Services for reimbursement within ten (10) working days after completion of the approved activity.
Actual expenses more than estimated will be paid in accordance with the provisions of the attached procedures. VERIFICATION
OF COMPLETED COURSE WORK IS REQUIRED. I understand that failure to complete a pre-paid activity will require me to
reimburse the Professional Growth fund. I certify that these expenses are not being reimbursed from any other source. I further
understand that due to a change in the tax laws effective July 1, 1992, the District is required to report educational reimbursements
paid to employees as a taxable benefit and that it is my responsibility to contact my tax consultant to discuss my individual tax
liability at the time of filing my taxes.
_________________________________ __________________
Employee’s Signature Date
