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MSD Southwest Allen County
Professional Conference/Meeting Application

Complete all information and submit the entire copy to the Assistant Superintendent for approval. Following approval, copies of the form will be sent to applicant's school office, the district's business office and to the applicant. Reimbursement will be made for approved conference/meeting upon submission of a completed claim and itemized conference/meeting receipts within 30 days to the district's business office following the conference/meeting. Payment is made after the next regularly scheduled board meeting.

Name (one name per application)

Email

 (Check one)  
 Certified     Classified     Administrator
School/Building:


 Date Submitted:  
I wish to make application to attend: (Name of conference/meeting)

Please specify the website URL or a link to the content of conference/meeting.
Departure Date:     Departure Time:  First session begins at:  
Date(s) of conference/meeting
Beg:             End:  		Location: 
Substitute required:  Number of days sub needed:    (.5 for half day)
Applicant's signature:   
*Registration
*Corporation will not reimburse for membership costs or tution-for-credit expenses. 		=$ 
Mileage:              @ 0.67/Mile =$ 
Airfare =$ 
Lodging:                        Nights
(Lodging is $150/night. Lodging not reimbursed for conferences within 125 miles of SACS) 		=$ 
Meal allocation *$45 max/day                     Days
*Meals are a taxable benefit for conferences/meetings that DO NOT require an overnight stay. Meal allocation breakdown: $10/breakfast, $15/lunch and $20/dinner 		=$ 
Other (i.e. parking)    =$ 
Total =$  recalculate
Funding Source (check one):   Teacher Requested (Not to exceed $450)     School Initiated
 District Initiated     Extra-Curricular     Special Ed Initiated--Sped#
 Other              $____________Total Reimbursement Approved
Account#