Faculty Professional Development Activity Form

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Please complete form, then email the Academic Senate Administrative Assistant, Elizabeth Rivera (elizabeth.rivera@napavalley.edu) with supporting documentation to assist the Professional Learning Committee with approving your request.

Email *

Name

Division/Department

Date of activity

Amount of funding requested

Does this activity require travel? *If yes, please review the the Business & Finance Travel Reimbursement process to submit proper documentation.

Yes

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Type of activity

Individual professional development activity you plan to attend in the future (i.e., conference, lecture, course, observation) Note: If an advance to pay for expenses is needed, please submit several weeks prior to activity to allow for processing.

Professional Development Training

Other:

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Please provide a brief description and the purpose of the activity below:

Please provide the relevance of your activity to the strategic plan initiatives, SSSP, Student Equity, division or department’s goals, and/or teaching assignment:

Please verify, by clicking the boxes below, that you have received written approval (via email) for this activity.

I have obtained approval from my Program Coordinator.

I have obtained approval from my Division Dean.

A copy of your responses will be emailed to the address you provided.

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