Pasadena Area Community College District
APPLICATION FOR PERSONAL/PROFESSIONAL GROWTH BENEFIT
Instructional Support Services Unit
Name Social Security Number
Department Contract Year 20
College Attended
I hereby apply for the following benefit (check appropriate area):
NOTE: As a benefit, these amounts will not be subject to payroll deductions.
_____ Up to $250.00 for completing three (3) or more semester units of lower-division credit at a
school accredited by the Western Association of Schools and Colleges
_____ Up to $425.00 for completing three (3) or more semester units of upper-division or
graduate credit at a school accredited by the Western Association of Schools and
Colleges
My expenses were:
Tuition
Books
Fees
Other instructional materials
Total
I certify that
I have attached an unofficial transcript or grade slip as proof of satisfactory completion.
The units were completed during the current contract year.
The units were earned on my own time at no District expense.
I earned a grade of “C” or better on the applicable units.
I understand that I may earn only one of the above benefits each contract year.
I understand that an application for the Personal/Professional Growth Benefit must be
submitted within one semester following the same year that course work is completed.
I have attached original receipts.
Signature Date
SUBMIT APPLICATION TO THE HUMAN RESOURCES OFFICE (C204)
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Human Resources
Benefit Amount _______________
Transcript Verified _______________
Contract Year Earned _______________
Approved for Payment _______________
cc: Fiscal Services
Employee
professional growth - issu (01/08)
