Holy Spirit Catholic ATA Local #5

Holy Spirit Catholic ATA Local #5

2015/16PROFESSIONAL DEVELOPMENT FUNDS CLAIM FORM

NAME: ______
SCHOOL:______PHONE#: ______
DESCRIPTION OF PD ACTIVITY: ______
PLACE OF PD ACTIVITY: ______DATES OF PD ACTIVITY: ______
Is this claim being submitted prior to attending the PD activity? YES NO
(If yes, complete the Substitute Costs, Registration, and Travel sections below. Attach receipts showing paid registration and travel costs). After this PD activity, submit a claim (with receipts) for other expenses.
orHas a prior-to-attending claim been submitted for this PD activity? YES NO

TOTAL AMOUNT AVAILABLE in your PD Fund Account $______

Substitute costs are set asidefirst from professional development funds. If substitute costs are not being paid using your Professional Development Fund, do not claim them on this form.
Substitute Costs:______days @ $______
Substitute costs = $202.40/full day and $101.20/half day
Friday is a full day substitute cost. /

Total Substitute costs

$______
EXPENSES:Receipts must be attached for all expenses except meals and private residence.
Registration:(attach receipt showing paid registration cost) / Total Registration costs claimed
$______
Travel:
Mileage (see chart on reverse) ______km@ $0.53 = $______
Air/Bus Fare (attach receipt) = $______
Taxi Fare (attach receipt) = $______/ Total Travel costs claimed
$______
Accommodation: (attach receipt)
Room cost only (including taxes) = $______
Parking = $______
Private Residence ($50.00/day no receipts necessary) = $______/ Total Accommodation costs claimed
$______
Meals: (maximum allotment – no receipts necessary)
Breakfast $12 x______= $______
Lunch $20 x______= $______
Dinner $30 x______= $______/ Total Meals costs claimed
$______
Other PD: (attach receipt)
Professional Affiliation/Subscription Fees, Post-Secondary Tuition, Professional Books, etc. / Total Other PD costs claimed
$______
TOTAL PD EXPENSES (CAD)
$
Reimbursement = Total amount available in your PD Fund Account – Total Substitute costs
Total amount paid from PD Fund Account / TOTALREIMBURSEMENT(CAD)
$
ATA-PD Chair Signature /Date

MILEAGE CHART:

Automobile use will be paid in accordance with the following chart. Centers not on list will be based on distance as indicated by current road maps.

DISTANCE (RETURN) / KILOMETERS / RATES
@ $0.53
per km / DISTANCE (RETURN) / KILOMETERS / RATES
@ $0.53
per km
Lethbridge to Banff / 728 / $385.84 / Lethbridge to Kananaskis / 636 / $337.08
Lethbridge to Bow Island / 220 / $116.60 / Lethbridge to Medicine Hat / 346 / $183.38
Lethbridge to Brocket / 164 / $86.92 / Lethbridge to Missoula / 1050 / $556.50
Lethbridge to Calgary / 462 / $244.86 / Lethbridge to Nanton / 262 / $138.86
Lethbridge to Camp Impeesa / 270 / $143.10 / Lethbridge to Picture Butte / 63 / $33.39
Lethbridge to Canmore / 644 / $341.32 / Lethbridge to Pincher Creek / 206 / $109.18
Lethbridge to Claresholm / 184 / $97.52 / Lethbridge to Red Deer / 750 / $397.50
Lethbridge to Coaldale / 38 / $20.14 / Lethbridge to Taber / 106 / $56.18
Lethbridge to Edmonton / 1058 / $560.74 / Lethbridge to Vulcan / 196 / $103.88
Lethbridge to Fort MacLeod / 100 / $53.00 / Lethbridge to Waterton / 262 / $138.86
Lethbridge to Great Falls / 592 / $313.76
Lethbridge to Jasper / 1260 / $667.80
Lethbridge to Kalispell / 530 / $280.90

Early Submission:

• To ensure timely reimbursement of out-of-pocket expenses, a claim for registration fees and booked travel costs may be submitted prior to attending a conference. Substitute costs must be available. Receipts showing payment in full must accompany a prior-to-attending claim.

Travel:

• No reimbursement is made for use of reward points for travel or hotel.

Submission:

• Attach necessary receipts and submit to the PD Chair for initial approval. The PD Chair will check that expenses are recorded correctly and information is complete. The PD Chair will sign the form, and submit the form to the PD Fund Bookkeeper for payment. Sub costs are paid, on your behalf, directly to HSRCSRD#4.
• Your current PD Chair is Gay Lagler at St. Mary’s Taber.

Questions:

• The ATA- PD Policy is available from your ATA-PD Chair, your ATA-PD school rep, the ATA Local #5 website , HS4 PD Facebook group