Sunrise R-IX School District

Professional Development Request

(Revised 8/29/07)

Date of Request  ______________________

Employee Name  ________________________________

Event Name  ___________________________________ Event No.  _______________

                                                                                                                                                (If applicable)

Related to CSIP Goal(s)  _____________________  Strategy:  ______________

Event Location  _________________________________  Date(s)  ________________

Event Times  ______________________________________________

Registration Phone  _______________________  Fax  ______________________

Estimated Expenses

            Registration                                                                                  _______________

            Lodging                                                                                           _______________

                     No. of Nights _____  Dates  ____________________

            Travel (Mileage X $0.485)                                                               _______________

            Meals (Please return receipts.)                                                                    _______________

            Cost of Substitute ($70.00 per day)                                           _______________

            Miscellaneous (Parking, etc.)                                                       _______________

            TOTAL                                                                                             _______________

Other Attendees  ________________________________________________________

Note:  If your request is approved, please submit an Employee Leave Request Form.

PDC Committee Meeting Date  __________________        CSIP Goal(s)________________

Approved  _____     Denied  _____ Committee Chair  ____________________

Superintendent  _____________________________  Date  _________________