Faculty Development

Application Form A: Off-campus Conferences and Workshops

Today's Date:
9/18/2014

Last Name:


First Name:


Lewis ID:


College:

 College of Arts and Sciences
 College of Business
 College of Education
 College of Nursing and Health Professions
 School of Professional and Continuing Education
 
Department:


Faculty Status:

 Full Time
 Half Time
 
Email:


Office Phone:


PROPOSAL

Conference/Workshop Title:


Conference/Workshop Description: 


Dates:


Location: 


Please describe your participation in this workshop:

 Presentation
 Panelist
 Poster Presentation
 Attendee (includes session chair, moderator or officer)
 
What current University initiative does this conference/workshop support:

 Student Assessment
 Service Learning
 Online/Blended Learning
 International/Global Learning
 Mission Development
 Teaching Excellence
 
Please explain the relevance of this conference/workshop to your professional development as a faculty member at Lewis University.


BUDGET

Conference Workshop Registration and Fees:


Transportation Estimated Costs:

Airfare:

Reimbursement restricted to coach/economy

Taxis:


Shuttle:


Parking:


Train:


Bus:


Car Mileage:


Lodging - Room Rate with Taxes:


*Generally, overnight stays for Chicagoland conferences will not be funded. Please clarify reason for overnight stay in the Chicago area.

SUBTOTAL:


Dean’s Fund for Professional Development
Each full time faculty member is eligible for $350 per year from the Dean. You must use these funds first. Please subtract the $350 from your subtotal or provide a statement indicating how these funds have already been used.

Other Funding:
Will you receive funding for this conference from another source? If so, please specify:

TOTAL:

Note: Print this page for your records before submitting. Don't forget to submit your application after printing.