ࡱ> MOL] bjbj۷۷ 4<&\&\q\ \ 8LN4($(#######$&(V###kkkF#k#kkr"T#t4X^k"##0($y")=.)#)#|k##k($)\ |:  GREAT BASIN COLLEGE FACULTY SENATE COMPENSATION AND BENEFITS COMMITTEE PROFESSIONAL DEVELOPMENT FUNDS REQUEST FORM Name: __________________________________ Event: __________________________________ Dates: __________________________________ Location: ________________________________ Purpose of Conference or Event: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Benefit to College: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ How this will improve my teaching and/or department: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Meal Estimates: See the Per Diem handout Lodging Estimates: See the Lodging handout Mileage: See the in-state Mileage Map and the Per Diem handout.  Method of Transportation: ________________________________________________________________________________ ESTIMATED COST * Transportation: ___________________ Lodging: ___________________ Registration: ___________________ Meals: ___________________ Other: ____________________ Total Estimated Cost:  When traveling out-of-state, all receipts, except food, must be submitted: e.g., taxi, parking, motel, etc. _______________________________________ _____________________ Applicant's Signature Date _______________________________________ _____________________ Department Chair or Vice President Approval Date Please attach all relevant documents that could help the committee make a decision. (i.e., conference brochures, etc.) APPROVAL: Amount: ________________ _________________________________ ______________ Faculty Senate Compensation and Benefits Chair Date Amount: _______________ __________________________________ _______________ Prof Development/Vice President-Academic Affairs Date GREAT BASIN COLLEGE FACULTY SENATE COMPENSATION AND BENEFITS COMMITTEE Professional Development Funding Request Checklist Criteria Points Earned/Points Possible Applicant is applying for re-certification and/or licensing for Application not considered His/her technical field (Violates the committees boundaries) Applicant is applying for summer travel Application not considered (Violates the committees boundaries) The deadline for submission of request has been met ____/ 1 point (Submission must be received by Committee Chair prior to deadline below for Committee consideration) Fall Semester - October 31st Spring Semester - March 30th Constitutes allowable submissions per this container for the academic semester (Number of Container Voting Reps denote allowed submissions) ____/ 1 point Applicant is a presenter or co-presenter at this conference or event.*(see below) ____/ 3 points (Must include documentation in request packet) Amount of time that has transpired since last application approval. ____/0-2 points 0 point = Applicant received funds within one year. 1 point = Applicant has not applied for funding within last year. 2 points = Applicant has never applied for funding. Level of critical benefit to the institution. ____/0 3 points 0 point = no impact; personal development only 1 point = impact is at department/program level only 2 points = impact is across several departments/program levels. 3 points = significantly impacts the institution and/or majority of the student population. Degree of travel required for this Conference or event. ____/ 1 3 points 1 point = the rest of the 48 contiguous states 2 points = in a state bordering Nevada 3 points = within the state of Nevada Total Points Earned ______/13 Possible (1 point score minimum on bold items is mandatory for funding consideration) *Presenters are eligible for an additional 10% funding in excess of the established ceiling     Rev. 4-8-14 Page  PAGE \* MERGEFORMAT 1 |  NUMPAGES \* Arabic \* MERGEFORMAT 2 KwxyiWB0BB#hsB*CJOJQJ^JaJph)h?dh?dB*CJOJQJ^JaJph#h?dB*CJOJQJ^JaJph,hshb5B*CJOJQJ^JaJph,hshb5B*CJOJQJ^JaJph)h?dhbB*CJOJQJ^JaJph)hbhbB*CJOJQJ^JaJph/hbhb5B*CJOJQJ\^JaJph hbhbCJOJQJ^JaJ)hbhbB*CJOJQJ^JaJphKxy! " 3 4 9 : ` q d$&`#$/7$8$H$Ifgds$d7$8$@&H$a$gdb$d7$8$H$a$gdbd7$8$H$gdb ! 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