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Professional Personnel Inservice Request Form
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Central Early Childhood
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Request to Attend Inservice Workshop, Meeting, Conference, Etc.
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Employee Name:[name]
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Date of Request:
[date of request]
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Attendnace Center:
Central Middle School
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Discipline Area:
[discipline area]
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Grade Level:[grade level]
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Purpose of Inservice
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[purpose of inservice]
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Official Name of Inservice Meeting
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[name of inservice meeting]
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Location of Meeting:[location of meeting]
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Date(s) of Meeting:[date(s) of meetings]
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Number of School Days Involved:[number of school days involved]
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MUST REQUEST USE OF SCHOOL TRANSPORTATION OR CARPOOL - FOR MILEAGE REIMBURSEMENT.
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Item/ActivityDescription/ExplanationTotal CostTOTAL
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Registration -
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Lodging -
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Transportation[list miles] -
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Other -
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Substitute[delete cost of not needed]140 140.00
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Meals[$50 a day for meals - the $50 will be pro-rated per meal} -
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 -
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 -
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[42]TOTAL $ 140.00
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Budget to be used to pay the fees:[budget]
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Must
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Conferences You Attended Previous and Current Year
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[conferences you attended previous and current year]
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Administrator Signature:[signature]Date:[date]
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Superintendent Signature:[signature]Date:[date]
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