Approval Request Form, Prek-5 - District Staff Development

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Approval Request Form, Prek-5

Directions: In order to qualify for staff development funds, you need to supply the following information. When you submit the form, it will be sent automatically to Melissa Podratz.

Please allow 2 weeks for approval to be granted.

Once granted, you will be responsible to register and keep receipts of approved reimbursements. Within two weeks following the professional development activity, you will need to fill out a post-activity form, sign it, and submit it, along with claim form for approved reimbursements if needed, to District Staff Development Chair Nathan Thompson. He will sign it and then you can be reimbursed. (This is for state reporting purposes.)


First Name:	*

Last Name:	*

Phone:	*

Email:	*

Teaching position	*

Campus	*

Alignment Goal Selections You must align your request with at least two goals. To do this, 1. Select a Site Goal from the first pull down menu that aligns with your reimbursement request. 2. Select a Site Goal from the second pull down menu that aligns with your reimbursement request or select a District Goal that aligns with your reimbursement request from the third pull down menu.

First Site Alignment Goal Selection	*

Select second alignment goal here or from the next pull down menu

If selecting only one Site Goal instead of two, you must select a District Goal that aligns with your your activity

Name of Activity	*

Date of Activity	*

Required Activity Description We need specific information about your activity besides the name and date, i.e. activity description, location, etc. You can provide this in one of three ways: You can enter the information. You can submit the url for the site that provides such informaion. You can upload a copy of whatever handout was used to publicize the activity. You must select one of the next three options to provide the necessary information.

Enter the description of your activity from the flyer, including location

Enter the url for the activity description

Upload file of activity description

Sub Pay (Budget $150 per day)

Mileage @ $.575 per mile

Other Expenses, Itemize and Give Cost

Total Fund Requested	*

If approved, be able to answer the following on a Post-Activity form in order to be reimbursed. 1. Findings: (Why is this activity needed at this time to strengthen your/students’ growth?) 2. Impact on Student Learning: (How will this activity strengthen your students’ growth?) 3. Impact on Teacher Learning: (How has this activity strengthened your professional growth?)

Send a copy of the completed form to this email address :

* Indicates Required fields.