Desert Regional Consortium
Request for Staff Development Funds
(Requests will not be accepted after travel has occurred)

College/Participant Information

College Name:
Traveler(s) Name:
Traveler(s) Position(s):
E-mail Address:		Telephone #:

(Do not enter more than one ethnic or discipline category)	Ethnicity of Professional Staff Served:						Gender of Professional Staff Served:
Discipline:	AS	BL	H	AI	W	O	Male	Female
General/Academic Education
Vocational Education
Guidance/Counselor
Instructional/Student Support
Business/Industry Partners
Total
Enter the demographics of the professional staff served.  The collapsed categories for ethnicity are from the MIS data element dictionary EB04 Employee Ethnicity: AS-Asian, Filipino, Pacific Islander; BL-Black, Non-Hispanic; H-Hispanic; AI-American Indian/Alaskan Native; W-White, Non-Hispanic; O-Other (also including unknown, and non-respondent)

Proposed Staff Development Activity
Description (i.e., name of conference)
Location (City, State)	City: State:
Dates of Travel
Description of Activity (purpose for participant in this staff development activity and how it fits within the objectives of the Desert Regional Consortium)

Funds Requested: (Provide approximate costs, rounded to the nearest dollar)
	Amount
Incidentals, parking, tolls, etc.	$	Registration	$
Meals (not covered by the conference, at district rates) List # of meals x $ average cost per meal.	$	Airfare	$
		Car Rental	$
Lodging List # of nights x $ daily rate.	$	Other Costs:	$
ESTIMATED TOTAL EXPENSE			$

Staff Development Request-Desert Regional Consortia (11/05)

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Submission Procedures

This completed form, along with a copy of the staff development announcement (i.e., flyer, invitation, conference brochure, etc.), must be submitted to the Desert Regional Consortium Coordinator: Julie Pehkonen, Riverside Community College, 4800 Magnolia Ave, Riverside, CA 92506. E-mail: Julie.Pehkonen@rcc.edu ; Phone: (951) 222-8026; Fax: (951) 222-8877

Notification of Approval Requests will be reviewed and approved by the Desert Regional Consortium at a regularly scheduled meeting (Refer to http://desertcolleges.org/ for meeting dates.) You will be notified after the consortium meets as to the status of your request. A purchase order will be issued to your college for the amount of funds approved. For non-RCC employees, reimbursement from RCC will be made to colleges ONLY, and will not be paid directly to participants.

Requests for Reimbursement: Upon completion of the approved activity, you will need to submit a written summary of the activity, an invoice from your college, expenditure documentation, and activity documentation to the consortium’s coordinator (see above). Written Summary: Provide a written summary of the activity. Limit your summary to one page or less and include the benefit derived from your participation in the activity. This summary will be placed on the region’s website, and you may be asked to discuss the activity at a regional consortium meeting. Invoice: The invoice should be for the amount of funds expended and should not exceed the amount approved by the consortia. Expenditure Documentation: Appropriate documentation to support the expenditure/invoice amount could include any of the following: copies of your completed expense report and receipts, copies of invoices, or copies your college’s financial summary sheet showing expenses were paid. The aforementioned describes the types of documentation that can be used, but other appropriate documentation may be substituted (contact the coordinator to inquire). Conference hand-outs: Information such as the agenda, handouts from sessions of the conference/professional development session, and whatever other information you feel adequately records the purpose of the conference. The invoice and supporting documentation will be kept with the Desert Regional Consortium’s audit records.

Staff Development Request-Desert Regional Consortia (11/05)