Academic Senate Request for Travel Funding

Conference Information
Conference Title*
Host Organization for Event
Description of Conference/Event*
Conference location*
Conference Dates
From*
Date Format: MM slash DD slash YYYY
To*
Date Format: MM slash DD slash YYYY
Additional Dates?*
- Yes
- No
Additional Dates*
List any additional dates here
Explain Additional Dates*
Professional Development Category*
- Instructional/Pedagogy
- Career Enhancement
- Discipline Specific

Conference Expenses / Estimated Costs
Registration Fees
Airfare or mileage fee
Hotel
Number of nights
Cost per night
Total Hotel Expense
Meals ($41/day)
Taxi/Shuttle
Parking
Total Estimated Expenses
Each request is limited to a total sum of no more that $1500. If your estimated expenses total exceeds $1500, please indicate your source of funding for the amount beyond $1500.

Value Statement
In a brief paragraph, explain how this conference applies to your current assignment. Please be specific about how it will promote student learning outcomes, success, and/or completion through the use of high impact practices.*
Reference: High Impact Practices
How will this conference/event help you to support innovation and technological improvement to instruction and the institution?*
How will this conference/event help you to promote equity and close or reduce student achievement gaps?*
Reference: Equity
Reference: Student Achievement Gaps

Learning Expectations
How do you intend to incorporate the information or experience into your instruction or service to students?*
How do you plan to share out what you have learned?*
Reference: Sharing-out Report
Check all that apply.
- Academic Senate
- Flex Day
- Departmental Share-out
- Lunch & Learn
- New Faculty Seminar
- PCC Faculty Peer Mentor Program
- Other
Other way(s) you plan to share out what you have learned*

Accountability/Achieving the Goals of the Educational Master Plan and Agreement
Which parts of the Educational Master Plan (EMP), Vision for Success, and/or PCC's Mission Statement will this conference attendance address?*
Identify up to three (3) specific areas that are the most applicable.
Reference: EMP Executive Summary
Reference: Vision for Success
Reference: PCC's Mission Statement
Agreement*
- By checking this box, I agree to the following statement:
I agree to execute my share-out plan within 3 academic calendar months of attending this conference and will submit a sharing-out report to the Faculty Development Committee chair within 2 weeks of the share-out. I understand that if I fail to do this, I will not be eligible for funds during the next academic year. I also understand that this information may be archived on the Professional Learning website for public viewing.
Comments
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Applicant Information