Dartmouth Local PD Application Form 202 Brownlow Avenue, Suite A200 * Dartmouth, NS * B3B 1T5 Phone: (902) 461-4187 Fax: (902) 468-7782 This is an official application form. Name: Professional #: Mailing Address: Home Phone: School Phone: Current School: Email Address: * Required Teaching status: Term Probationary Permanent Type of funding requested: Conference Workshop Institute Conference Location: Start Date: End Date: Brief Conference Description: (include web address if available) Expense Details: Include Original Receipts. (If not claiming registration expenses, attach a copy of the receipt as proof of attendance). (Transportation, accommodations, and meals are at the discretion of the committee) Registration: $ (include receipts) Airfare: $ (include receipts) Accommodations: $ (outside HRM only) Meals: $ ($30 daily max with receipts) Travel: $ (outside HRM, gas only no mileage) Total: $ Have you applied to HRSB / NSTU Article 60 for funding? Yes No If the answer is no, this application will not be processed unless one of the following applies to you: I have reached my limit under Article 60 I was rejected Have you received funding from the Dartmouth Local PD Committee during the current fiscal year (July 1 - June 31)? Yes - Amount: No Please note: ORIGINAL RECEIPTS are required to be submitted with your claim form. COPIES WILL NOT BE ACCEPTED.
Dartmouth Local PD Application Form 202 Brownlow Avenue, Suite A200 * Dartmouth, NS * B3B 1T5 Phone: (902) 461-4187 Fax: (902) 468-7782
This is an official application form.
Name: Professional #: Mailing Address:
Home Phone: School Phone: Current School:
Email Address: * Required Teaching status: Term Probationary Permanent Type of funding requested: Conference Workshop Institute
Conference Location: Start Date: End Date:
Brief Conference Description: (include web address if available)
Expense Details: Include Original Receipts. (If not claiming registration expenses, attach a copy of the receipt as proof of attendance). (Transportation, accommodations, and meals are at the discretion of the committee)
Registration: $ (include receipts) Airfare: $ (include receipts) Accommodations: $ (outside HRM only) Meals: $ ($30 daily max with receipts) Travel: $ (outside HRM, gas only no mileage)
Total: $
Have you applied to HRSB / NSTU Article 60 for funding? Yes No
If the answer is no, this application will not be processed unless one of the following applies to you: I have reached my limit under Article 60 I was rejected
Have you received funding from the Dartmouth Local PD Committee during the current fiscal year (July 1 - June 31)? Yes - Amount: No Please note: ORIGINAL RECEIPTS are required to be submitted with your claim form. COPIES WILL NOT BE ACCEPTED.