Request to Attend Professional Development 18-19
IMPORTANT:
It is imperative that you complete the leave forms for your district following their procedures. Please ensure you receive prior approval from your district for leave.

This form is for use of funds from the Region 10 Low Incidence projects through the following grant funds:
Formula – 421 – Individuals with Disabilities Education Act (IDEA) Special Education Part B Section 611 Regional Low Incidence Discretionary Federal Fiscal Year (FFY) 2018, State Fiscal Year (SFY) 2019 Catalog of Federal Domestic Assistance (CFDA) 84.027A, Special Education – Grants to States (U.S. Federal Award Number H027A180087)
Application for Federal Funding

Intergovernmental Agreement Finance Code – 423 – Individuals with Disabilities Education Act (IDEA) Part C (Ages 0-2)
Federal Fiscal Year (FFY) 2018, State Fiscal Year (SFY) 2019 Regional Interagency Early Intervention Committee (IEIC) Grant Catalog of Federal Domestic Assistance (CFDA) 84.181, Special Education Grants for Infants and Families with Disabilities (U.S. Federal Award Number H181A180029) Application for Federal Funding

Formula – 430 – Individuals with Disabilities Education Act (IDEA) Part B Section 619 Centers of Excellence Discretionary Regional Comprehensive System of Personnel Development (CSPD), Ages 3-5 Federal Fiscal Year (FFY) 2018, State Fiscal Year (SFY) 2019 Catalog of Federal Domestic Assistance (CFDA) 84.173, Special Education – Preschool Grants (U.S. Federal Award Number H173A180086) Application for Federal Funding

Formula – 432 – Individuals with Disabilities Education Act (IDEA) Special Education Part B Section 611 Regional Low Incidence Comprehensive System of Personnel Development (CSPD) Discretionary Federal Fiscal Year (FFY) 2018, State Fiscal Year (SFY) 2019 Catalog of Federal Domestic Assistance (CFDA) 84.027A, Special Education – Grants to States (U.S. Federal Award Number H027A180087) Application for Federal Funding

Intergovernmental Agreement Finance Code 446 – Individuals with Disabilities Education Act (IDEA) Part C Centers of Excellence Regional Comprehensive System of Personnel Development (CSPD), Ages 0-2 Federal Fiscal Year (FFY) 2018, State Fiscal Year (SFY) 2019 Catalog of Federal Domestic Assistance (CFDA) 84.181, Special Education Grants for Infants and Families with Disabilities (U.S. Federal Award Number H181A180029) Application for Federal Funding

Full Name *
I, am requesting permission to attend an educational seminar, in-service or professional conference.
Your answer
Email *
Your answer
Conference / Activity Name / Location *
Your answer
Select the most appropriate purpose of the event *
Hotel Name *
Indicate NA if no hotel is needed
Your answer
Hotel Address
If requesting Hotel
Your answer
Hotel Phone
If requesting hotel
Your answer
Hotel Arrival Date
MM
/
DD
/
YYYY
Hotel Departure Date
MM
/
DD
/
YYYY
Estimated cost for hotel *
Enter $0 if no hotel is needed.
Your answer
Estimated Mileage Costs *
$.545/mile (required if requesting reimbursement) - Enter $0 if no mileage is required
Your answer
Registration Costs *
Enter $0 if no registration costs are required
Your answer
Meal Reimbursement *
Enter $0 if there are no meal costs: Breakfast - $9.00, Lunch - $11.00, Dinner - $16.00, maximum daily limit - $36.00
Your answer
I understand that by entering my full name and submitting this form I am requesting permission to attend an educational seminar, in-service or professional conference. *
Enter full name
Your answer
Submit
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