Union City Area School District
REQUEST FOR PROFESSIONAL DEVELOPMENT
- CONFERENCE, SEMINAR OR WORKSHOP -
NAME __________________________________________ DATE _______________________
**ONE FORM PER PERSON *** DO NOT REGISTER UNTIL YOU RECEIVE NOTIFICATION OF APPROVAL**
Step 1: STAFF MEMBER: Information on the conference, seminar or workshop must be attached. Approval by
Principal and Director of Curriculum is necessary before registering for any event. Also please include preferred lodging
details.
Name of event: ______________________________________________________________
Date(s) of event: ______________________________________________________________
Where is the event being held? ___________________________________________________
A substitute is needed for _______ day(s). (Fill out Step 2 “Leave Request Form”down below.)
Registration fee: _________________ Roundtrip mileage from Union City: _________________
Preferred Lodging: _________________________________________ Est. Cost ____________
Booking dates needed: ____________________________________________________________
How are you required to register for this event?
paper “CourseWhere(IU) Other _________________________
CONFERENCE INFORMATION MUST BE ATTACHED.
(Retain copy of this form and attachments.)
SUBMIT TO PRINCIPAL Do not register until you receive notification of approval.
Step 2: Leave Request Form
I will need a substitute for the following dates: _________________________________________
_____________________________________ _____________________
Employee signature Date
.
Step 3: PRINCIPAL: Please review above request and approve or deny. (please circle)
Principal’s signature: ___________________________________ APPROVE DENY
Return denials to staff member. Send approvals (with required attachment) to the Dir. Of Curriculum’s office.
Step 4: DIRECTOR OF CURRICULUM (please circle)
Event Approved Event Denied
__________________________________
Dir. Of Curriculum or Designee’s Signature
Revised 5/2/19 See attached travel info on reverse side
Union City Area School District
STAFF MEMBER: (Following approval of event)
Mail any required registration paperwork promptly to the establishment that is providing the conference,
seminar or workshop.
For IU registrations: Register promptly following notification of approval at www.iu5.org (click on “Register
icon). Contact Joanna Butcher (Ext. 5452 or jbutcher@ucasd.org) if you have questions about payment
options or reimbursement.
Lodging: Call or go online and complete reservation at preferred hotel. Select to either pay by check, send
purchase order or be invoiced. Send a copy of all information to Joanna Butcher in Admin so payment can be
completed. Send any lodging receipts or confirmations to Joanna to be attached to paperwork.
For reimbursement, following event please submit a copy of your approved professional development form, and
a completed “Travel Expense Reimbursement” form
(found on website) with itemized receipts attached for all
expenses (registration, mileage, food, tolls, parking, etc.) to Joanna Butcher in Administration.
o Please note the maximum per day allowance for meals is the lessor amount of the actual meal
cost for the day or $30.00.
o The IRS establishes the reimbursable mileage rate each year so it will vary. Please use the form
on the website as it is the most up to date with the accurate rate.
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