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PDC Request for Funds
Please submit by 5:00 p.m. on the Friday before the PDC meeting prior to the conference.
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* Indicates required question
Name
*
Your answer
Email Address
*
Your answer
Building
*
High School
Middle School
Upper Elementary School
Elementary School
Primary School
Teaching Assignment
*
Your answer
Activity
*
Workshop/Conference
Your answer
Will you be traveling with others from our district?
*
Yes
No
Location of Workshop/Conference
*
Your answer
Date of Activity
*
Your answer
Will this workshop affect student achievement?
*
Yes
No
Has your administrator approved for you to share the information learned from this workshop/conference with your peers?
*
Yes
No
Are there other monies available for this workshop/conference?
*
Possible other monies may include Title 1, building funds, etc.
Yes
No
Are you willing to pay for lodging, meals, and gas?
*
Yes
No
Will this workshop/conference bring more resources to our school that were previously not available?
*
Yes
No
Link to Conference Webpage (Optional)
Copy and paste from web browser
Your answer
Cost: Registration/Fees
Your answer
Cost: Lodging
Your answer
Cost: Roundtrip Mileage ($.45 per mile)
Calculate from your school building; No mileage paid for Springfield.
Your answer
Cost: Meals
$20.00 per day if local; $30.00 per day for overnight stay
Your answer
Total Cost
*
All expenses added together (The total amount you are requesting)
Your answer
Electronic Signature
*
Please type your full name
Your answer
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