Elementary Professional Development Fund Application Form Question Title * 1. Name: Last/First OK Question Title * 2. I am a contract elementary teacher with the UCDSB (not on recall) and therefore a member of the ETFO-UCL. YES OK Question Title * 3. Is this your first or second application this school year? First Second OK Question Title * 4. School/worksite: OK Question Title * 5. UCDSB Employee number: OK Question Title * 6. School/work site telephone: OK Question Title * 7. School/work site fax: OK Question Title * 8. Email Address: OK Question Title * 9. Email Address confirmation: OK Question Title * 10. Personal Phone Number: OK Question Title * 11. Professional Activity: seminar conference course workshop Other (please specify) OK Question Title * 12. Title of Activity or Course: OK Question Title * 13. Activity Provider: OK Question Title * 14. Beginning Date: Date / Time Date OK Question Title * 15. Completion Date: Date / Time Date OK Question Title * 16. Funding Request - (A maximum of $1000, including the OT costs, will be provided. Please estimate other costs to their predicted maximum). Registration Fee: OK Question Title * 17. Accommodation Fee OK Question Title * 18. Car Travel: (km X $0.64) OK Question Title * 19. Other Travel: (train/plane/taxi) OK Question Title * 20. Meal Costs: (max. $100/day) OK Question Title * 21. Parking Costs: OK Question Title * 22. Other Expenses: (with explanation) OK Question Title * 23. Occasional Teacher Required: none 1/2 day full day Date(s) OT required: OK Question Title * 24. I have read the Terms of Reference on the ETFO-UCL website: http://www.etfo-ucl.on.ca/profdevfund.html : YES OK Question Title * 25. Required Notification: Once approved, your principal will be notified of this activity if it occurs during the instructional day. I understand OK DONE