Library Office

Request for Funding for Professional Development

Today's Date :

Name of Applicant:
E-mail of Applicant:

Event:

Location:

Start Date:
End Date :

Reasons for wanting to attend (check all that apply):

Learn

Network

Attend meeting(s)

Facilitate session(s)

Present

Invited Speaker Yes No

Take training

Conduct research

Please address your request in the context of the Criteria for Funding:

Leave of absence with pay for specific dates Start Date:
End Date:

Estimated Costs in CAD dollars:

Original currency (e.g. USD):

Conversion rate used (e.g. 1.00 USD = 0.98 CAD):

(For currency conversion see http://www.xe.com/ucc/.)

Registration + Taxes:

(Where applicable, registration will be funded at the member and/or early bird rates.)

Transportation + Taxes:

(principal method of transportation, e.g. car, train, plane, taxi):

Accommodation + Taxes:

# of nights

Meals:

Original receipts required.

Maximum $70 CAD in Canada
(Breakfast – 17.50; Lunch – 17.50; Dinner – 35.00)
Maximum $80 CAD outside Canada and in North America
(Breakfast – 20.00; Lunch – 20.00; Dinner – 40.00)
Maximum $125 CAD outside North America
(Breakfast – 31.25; Lunch – 31.25; Dinner – 62.50)

Other costs (specify):

Cost Name Amount
Cost Name Amount
Cost Name Amount

Estimated Grand Total (CAD):

Are you receiving funding for this event from any other organization?

Yes No

If yes, name of organization:
Amount:
To cover which expenses?

Are you a member of the association/body sponsoring the event?

Yes No

How much professional development funding have you received or had approved in the fiscal year for which this application applies (May 1 - April 30)?

Amount:

Manager's Approval and Signature:

When you "Submit", this form will be sent to the manager whose name you select from the Name of Manager drop-down menu. Your manager will consider your request in consultation with his/her manager. If funds requested exceed $1,500 CAD in the fiscal year for which this application applies, the Library Executive Committee will consider your request.

March 2012

Carolyn Vincent, Secretary to the University Librarian

April 3, 2012