Request For Professional Leave

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Request For Professional Leave - Middle

This form MUST be completed two weeks prior to the conference date.

All registrations and other expenses must be paid by the employee and will be reimbursed by the Board of Education up to the maximum amount approved as long as the actual expenses, actual mileage and receipts are submitted within 30 calendar days of the conference date. Failure to do so will cancel the reimbursement.

Email *

Name *

Date of leave requested/First date if attending multiple days *

YYYY

Number of Conference Days

1/2

Other:

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Conference Title *

Location *

Is a substitute required? *

Yes

Is this leave mandatory? *

Yes

If this leave is NOT mandatory, explain how this leave is connected to the Academic Content Standards or to your Individual Professional Development Plan. (Please write N/A if it is mandatory)

Registration Amount ($200 max, per contract) *

Estimated Meal Amount ($50 per day, per contract) *

Estimated Room Amount ($100 per night, per contract) *

Estimated Number of Miles: *

Other Estimated Expenditures

Send me a copy of my responses.

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