REQUEST FOR STIPEND
Adjunct Faculty College-Sponsored Development Activity
Part I
Submit for approval at least one week, but no more than one month, prior to the date of the
activity.
Name:
Mailing Address:
Division: ☐ AHHS ☐ SSBU ☐ STEM ☐SDEV ☐ LIB
Campus: ☐Jamestown ☐ Olean ☐ Dunkirk
Activity:
Activity Date:
This is my ☐ 1
st
☐ 2
nd
☐ 3
rd
☐ 4
th
request this academic year, September 1 – August
31 (maximum of 4)
Briefly explain how this activity is related to your development as a JCC faculty member:
Signature _________________________________ Date _________________
(Division Dean or Director of Libraries)
Approved
Tentatively Approved
Denied
Explanation of decision (if needed):
Part II
Please confirm and return to your Academic Affairs Assistant after activity has been completed.
This must be received within 2 weeks of the completed activity.
I have completed the activity described above.
Signature _________________________________ Date _________________
9.3.20
