In-District: ____ Out-of-District: ____ Out-of-State _____
Title of
Conference: ____________________________________________________________
Location:
_____________________________________________________________________
Subject of
Conference: _________________________________________________________
How will this conference impact your program?:
___________________________________
_____________________________________________________________________________
Significance of
Conference to College: ____________________________________________
_____________________________________________________________________________
Date(s) of
Conference: Start Date: ________________ Stop Date: _____________________
Cost to
District_____No_____Yes
If any cost to
District, please fill in below (Please Note: Must also fill in proper Travel
& Transportation Request for prior approval and attach.):
Registration Fee
of Conference: $ _________________
Meals: $
__________ $ ____________ $ ____________ $ ____________
Lodging: $
_____________
Transportation:
College transportation:
$_____________________
Private vehicle: Mileage: _____
Amount/Mile $ _______ Total $ __________
Public transportation: $
______________________
Other Funding
Available:
Source:
_______________________________________________________________
Amount: $
____________________________
Comments:
______________________________________________________________________________________________________________________________________________________
Applicant: ________________________ญญ__________________
Date:_____________________
Approved:
__________ Disapproved: __________
Dean: ________________________________
Date: ____________________