Professional Development Application Form 2018-19

PROFESSIONAL DEVELOPMENT APPLICATION FORM 2018-19

INDIVIDUAL EMPLOYEE AWARD

Email signed applications to Bridget Murray.

If relevant, please attach copies of signed out of state travel approvals.

Date of Application:
Your Name:
Your Division/Unit:
Phone:
Email Address:
Classification (Technical Faculty, General Education Faculty, LRC/Staff, Adjunct/Part-time):
Name of conference/activity:
Brief description of conference/activity
(150 words or less):
Web URL of conference/activity (if applicable):
Destination of travel:
Registration Deadline(s):
Dates of Travel:
Type of travel: / to
TOTAL FUNDING REQUESTED: / In-state Out-of-state Foreign
$

Checkany of the following that apply and provide requested information in 150 words or les

Describe your involvement in this activity (i.e. participant, presenter, leadership role/officer in professional organization, etc…):

I am in the last two years of the promotion cycle – with the stipulation ofplanning to go up for promotion.

Date planned to go up for promotion:

The PD activity is required to maintain certification and/or to teach or perform my job function in the program/discipline – not to include individual/personal licensure.

Describe the program/discipline requirement:

The PD activitydirectly addresses PD needs identified on my PPE.

Explain how this activity addresses your professional development, program/discipline area, and/or work assignment need(s) as described on your PPE:

The PD activity contributes to the overall mission and goals of Henderson Community College

List the goal(s) this activity supports, and describe how it contributes to the overall mission and goals of HCC:

The PD activity will impact/enhance the learning environment at HCC.

Describe how this activity will impact/enhance the learning environment at HCC:

I am willing to share what I learn from this activity with others in the college, the system, or community as appropriate.

Yes No

Describe how you will share what you learn:

Other college employees are attending this event.

Yes No

If other college employees are attending this event, explain why funding is needed for multiple attendees:

Division Chair/

Supervisor Signature of Approval:

By signing above you are confirming that you have reviewed this PD request to ensure alignment withyourdivision/unit goals, individual faculty/staff PPE goals, and you are supporting the faculty/staff participation in this activity.

Professional Development Committee Only

Funded: Not Funded: Waitlisted:

Faculty PD Coordinator ______

Academic Dean______

Amount Awarded: $

1