Bremerton School District
Application for
Classified Staff Development Funds
For Out-of-District Workshops Only
INSTRUCTIONS
· To complete the application, type in the information using the tab key to move to the next field. When completely filled out, print the form and get required signatures.
· Application forms must be complete and correct or they will be returned. Incomplete or illegible applications will not be accepted, which will delay the process of your application.
Name(s) of person(s)/group applying: / Occupation: / Location:Name of Activity:
Date and Location of Activity:
Person to be contacted: / Phone Number:
Describe the proposed activity and describe specifically how this activity will relate to your job responsibilities:
BUDGET
Substitute Cost (hourly rate plus benefits)
Paraeducator $12.97 per hr / Number of hours: / Sub Cost: $Secretary/Clerical $12.97 per hr / Number of hours: / Sub Cost: $
Maintenance/Custodial $15.17 per hr / Number of hours: / Sub Cost: $
Transportation $16.94 per hr / Number of hours: / Sub Cost: $
Total Substitute Cost: $
FEES
Note: If you have already registered or paid for this activity, please check here:
Fee per person: $ Number of applicants:
Total Fees: $
MEALS
Note: No breakfast on first day and no dinner on last day of journey. Meals provided at no cost to the traveler such as at conference or on plane, will not be advanced or reimbursed. Per diem rate will be based on location of workshop (rate will be computed by Personnel Office).
Total number of meals: Breakfast Lunch Dinner
Total Meal Cost: $
LODGING
Name and location of hotel/motel:
Nightly Rate: $ Number of Nights: $
Total Lodging: $
TRANSPORTATION
Mileage: Who will drive?
Number of miles: x .575 Total: $
Ferry, plane, bus, or other Total: $
Parking Total: $
Total Transportation: $
Total Funds Requested: $
Applicant(s) Signature
1. Date:
2. Date:
3. Date:
4. Date:
Principal/Supervisor Signature
Date:
For more information visit the District website at www.bremertonschools.org/Page/3461
Rev Jan 2015