BROOKDALE COMMUNITY COLLEGE

Application for Professional Development Committee

Financial Assistance

NAME ______DATE______


PHONE ______E-MAIL______

DEPARTMENT______DIVISION ______

(Please check the appropriate category)

Administrator/Exempt Faculty Staff

Conference ( Presenter or Attendee)

Workshop, Course, Seminar (Check all that apply.)

Technical Training

Discipline Specific or Broad

Off-Campus or On-Campus Online

Educational Materials (Please explain) ______

Other ______

Briefly describe the activity and attach copies of any brochures or related materials. Please note: This information may be shared within the campus community in a professional development context.

A. What: ______

B. Where: ______

C. When: ______

D. Why: Provide a rationale for the activity and its relationship to the following: (Check all that apply)

Matrix http://www.brookdalecc.edu/forms

PPO(Faculty) Perf. Management Form (Admin) Department Plan

______

______

______


Cost of activity:

1. Registration Fees: ______

2. Other Costs: ______

______

3. Total estimated cost for entire activity (Required): $______

4. Amount requested from the Professional Development Committee: $______

Maximum amount available from the Professional Development Committee per year:

$200 A&E/Staff $350 Faculty

Additional sources of funding: Supervisor, EVP

General Criteria for Awarding Funds

  1. Submit this completed application to your division administrator or supervisor for signature and he/she will forward it to the Professional Development Sub-Committee Chairperson.
  2. Proposed conference, workshop, etc., must relate to the Matrix, PPO/Perf. Management Form or Dept Plan.
  3. Funds are allocated on a first come/first served basis.
  4. Individuals may not request funds representing another individual’s potential allocation.
  5. Please contact the Professional Development Committee if your plans change and/or you do not use your PDC approved amount.

For the 2006-2007 Academic Year please return this form to the following Professional Development Sub-Committee Chairpersons as follows: (Division Administrators will forward)

Administrators/Exempt: Contact: Mary Ann Waclawik (OBCD) 732-224-2508

Faculty: For the following Divisions contact: Elaine Olaoye (Psychology) 732-224-2848 Arts/Communication

Health Science

Social Science

Business/Computer Science

Librarian

Faculty: For the following Divisions contact: Nancy Liu (Physics) 732-224-2884

English

Math

Science/Technologies

Student Development

Staff: Contact: Lynn Johnson (Biology) 732-224-2402

Your Signature ______Date ______

Div. Chair/Supervisor’s Signature ______Date ______

PDC Signature ______Date ______

Acct. Code ______Amount Approved $ ______

*Obtain forms from your division administrator or supervisor. Submit the completed forms to your division administrator or supervisor. For additional information, refer to the College Regulation 4.3501R Travel Expenses at the Brookdale Administration, Operations and Information Technology Services Web Page.

Revised 4/07 1