WEST VIRGINIA SUPREME COURT FOR AO USE:
ADMINISTRATIVE OFFICE Relevance: __________________________
Leave: _________________________________
************************** Meals/Lodging: ________________________
APPLICATION FOR Initials: ___________________________
EDUCATIONAL BENEFITS Date: __________________________________
Completion verified: __________________
************************** Tuition processed: _____________________
Term: _____ Fall 20___ Travel processed: ______________________
_____ Spring 20___
_____ Summer 20___
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Please type or print legibly and use a separate form for each course. For information on educational benefits, see West
Virginia Judicial Personnel System Manual, Sections 8.6, 9 and 10.
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INSTITUTION OR ORGANIZATION OFFERING COURSE: _____________________________________________________
LOCATION OF INSTRUCTIONAL MEETING(S): _____________________________________________________________
DAY(S) OR DATE(S) OF MEETING(S): ________________________ TIME OF MEETING(S): ________________________
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Name: _______________________________________________ Position: __________________________________________
Office address: ________________________________________________________________________________________
Phone: __________________________Fax: ______________________ E-Mail: _________________________________________
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COURSE RELEVANCE
1. Course title, catalog description and credit hours or number of instructional hours: __________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
2. _____ Undergraduate _____ Graduate _____ Non-credit continuing education
3. If the course is part of a degree or other program, name or describe the program: ____________________________________
______________________________________________________________________________________________________
4. Explain the relevance of this course to your official duties: ______________________________________________________
_____________________________________________________________________________________________________
5. Itemized estimate of educational expenses: ___________________________________________________________________
_____________________________________________________________________________________________________
6. Applicant’s signature: _____________________________________________Date:________________________________
7. Supervisor’s approval: _____________________________________________Date:________________________________
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EDUCATIONAL LEAVE is available for approved continuing education seminars, conferences and non-credited courses only.
Educational leave will not be granted for college courses. See Section 8.6 of the West Virginia Judicial Personnel System Manual.
I
do do not request educational leave time to attend the approved continuing education seminar, conference or non-credit
course.
FOR REIMBURSEMENT of costs, please see Section 9 of the West Virginia Judicial Personnel System Manual.
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Submit to
: Director of Judicial Education, Supreme Court Administrative Office, State Capitol E-100, Charleston, WV
25305 (Rev. 6/06)
