Approval Request Form - District Staff Development

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Approval Request Form, 6-12

Directions: In order to qualify for staff development funds, you need to supply the following information. When you submit the form, it will be sent automatically to Nathan Thompson.

Please allow 2 weeks for approval to be granted.

Once granted, you will be responsible to register and keep receipts of approved reimbursements. Within two weeks following the professional development activity, you will need to fill out a post-activity form, sign it, and submit it, along with claim form for approved reimbursements if needed, to District Staff Development Chair Nathan Thompson. He will sign it and then you can be reimbursed. (This is for state reporting purposes.)


First Name:	*

Last Name:	*

Phone:	*

Email:	*

Teaching position	*

Campus	*

Select Site Goal that aligns with your your activity	*

Select second Site Goal that aligns with your reimbursement activity or choose from the next pull down menu

If not selecting two Site Alignment Goals, you must select a District Staff Development Goal that aligns with your actiivity.

Name of Activity	*

Date of Activity	*

Activity Expense	*

Sub Pay (Budget $150 per day)

Mileage @ $.575 per mile

Other Expenses, Itemize and Give Cost

Total Fund Requested	*

If approved, be able to answer the following on a Post-Activity form in order to be reimbursed. 1. Findings: (Why is this activity needed at this time to strengthen your/students’ growth?) 2. Impact on Student Learning: (How will this activity strengthen your students’ growth?) 3. Impact on Teacher Learning: (How has this activity strengthened your professional growth?)

Note: You must select two goals that align with your activity per reimbursement request. One must be aligned with a site goal. The other alignment may be with another site goal or a district goal.

Send a copy of the completed form to this email address :

* Indicates Required fields.