Professional Development Funding Request Form

Click Here to access the Professional Development Funding Request Information page

First Name

Last Name

Your E-Mail Address

Department

Funding Request

Funding Request Indicate in which semester your event will occur.

Funding Request Indicate how much funding you are requesting (provide to nearest dollar).

Type of Professional Development Event Please provide the name of your event, website link, and information on the type of event you're interested in attending. For example: conference, workshop, continuing education courses.

Event Date

Date of Event

Year/Month/Day Hour:MinuteAM/PM

Fund Utilization

Please use the drop-down to indicate how the funds will be utilized.

If "other", please explain below

Additional Funding Sources

Do you have any additional sources of funding for this professional development opportunity?

If you selected "Other" to the previous question, please list any additional sources of funding for this professional development opportunity

Rational

Rationale for Funding Please provide a brief rationale for how attending this professional development event will help you enrich your current role or help you reach your desired position.

Questions or Concerns

Lingering Questions/Concerns

Please Read and Accept.

I understand that I can be awarded no more than $300 in funding.

Please Read and Accept

I understand that I may not be awarded the full amount of my request and that it is up to the discretion of the CEHDSA leadership team and the funds that are available.

Are you a robot?