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WCSD#1 Staff Travel Funding Form

Please complete the form below. Required fields marked with an asterisk *

WCSD#1 Staff Travel Funding Form

To be completed by the individual applying for funding.

Obligations or any travel arrangements made before approval may result in your being personally responsible for payment.

Name*

Answer Required

Email*

Answer Required

Today's Date*

Answer Required

This staff development activity is:*

[Please Check Appropriate Option]

Answer Required

Local Activity

Out-of-District Workshop (software and data trainings, etc.)

Out-of-District Conference (NCTM, NCTE, CEC, etc.)

Activity Date(s)

Start Date*

Answer Required

End Date*

Answer Required

Activity Location*

Answer Required

Travel Date(s)

Date Leaving*

Answer Required

Date Returning*

Answer Required

Conference/Workshop Title*

Answer Required

ESSA Consolidated Grant Goals: *

[Check the Appropriate Box(es) below that best describes your activity]

Answer Required

Increase student achievement consistent with the challenging State academic standards

Improve the quality and effectiveness of teachers, principals, and other school leaders

Increase the number of teachers, principals, and other school leaders who are effective in improving student academic achievement in schools

Provide low-income and minority students greater access to effective teachers, principals, and other school leaders

General Summary of Intent*

[Enter brief description of Intentions or Activity's Purpose]

Answer Required

Estimated Funds Needed (Costs and Specific Requests)

Registration Cost

[Enter Dollar Amount below, exclude $]

Answer Required

Lodging

[Enter Total Cost of Lodging, exclude $]

Answer Required

Number of Nights

Answer Required

Cost Per Night

[Enter Cost Per Night for Lodging, exclude $]

Answer Required

Preferred Motel Name

Answer Required

Sharing a Room With

[Enter Staff Name]

Answer Required

Meals (from per diem form)

[Enter Total Meals cost, exclude $]

Answer Required

Airfare

[Enter Total cost, exclude $]

Answer Required

Preferred Departure Date

Answer Required

Preferred Departure Time

Answer Required

Preferred Return Date

Answer Required

Preferred Return Time

Answer Required

Vehicle (42 cents per mile)

[Enter Round Trip total, exclude $]

Answer Required

Substitute ($100 per day)

[Enter Total Cost for Sub(s), exclude $]

Answer Required

Date(s) a Sub is Needed:

Sub(s) Start Date

Answer Required

Sub(s) End Date

Answer Required

Other

[Enter Other Costs, exclude $]

Answer Required

Explain Other Costs

Answer Required

TOTAL REQUEST

[Enter Total Request Amount (Add all Costs above), exclude $]

Answer Required

MUST BE FILLED OUT FOR APPROVAL

Account Number

[Enter Account Number]

Answer Required

Please enter Immediate Supervisor's Email in Confirmation Email below for Approval.

Confirmation Email

Confirmation Email *

Enter your email address here if you'd like to receive a confirmation upon submitting the form.

Email Required