<%@ Page language="C#" %> <%@ Register tagprefix="WebPartPages" namespace="Microsoft.SharePoint.WebPartPages" assembly="Microsoft.SharePoint, Version=12.0.0.0, Culture=neutral, PublicKeyToken=71e9bce111e9429c" %> Worcester State College

Worcester State College

Liberal Arts and Sciences Curriculum (LASC)

Application for Conference and Off-Campus Development Funding

Davis Educational Foundation Grant


Applicant Name:  *

Department/Campus Office/College Center Affiliation:
*

Contact Information:

            On-Campus Telephone: *
            Email:      *

Name and Location of Conference:  
*

OR

 Name and Location of Off-Campus Development Activity:
*

Dates of Travel or Conference Dates:
  *

Registration Cost:  Early:  $   *  General:  $ *

Other Conference Fees:  $ *

Please provide brief explanation.
 *

Total Transportation Costs Requested:  $ *

Airfare:  $ *

Ground Transportation (Shuttle or Taxi Costs):  $ *

Page 1  9/10/2008

     Automobile: $ * (total = mileage reimbursement plus tolls plus parking)

 

          Mileage: $  *
(# of miles from WSC to Destination and back)*(.54 per mile reimbursement)

          Tolls:      $ *

 

     Parking Fee(s):  $ *
(airport parking or hotel/conference parking fees)

           

Lodging (Hotel, Motel or Other):  $ *

Meals:  $ * (per diem for overnight travel; meals covered by the conference fee are not included)

 

Other Costs:  $

Please specify.

 

TOTAL REIMBURSEMENT REQUESTED:   $ *

(fees, transportation, lodging, meals, etc.)      

 

1.  Please explain why you wish to attend this conference or professional development activity and a brief explanation as to how this activity will contribute to LASC implementation including, but not limited to, course development.


  *

2.  Please provide a brief explanation as to how this conference or professional development activity will contribute to assessment efforts related to LASC.

  *

 

3.  Please indicate how information from the conference will be disseminated to the wider college community.  Please check all that you anticipate will be appropriate activities or venues for dissemination. 

 
   Present at a LASC/Center for Teaching and Learning On-Campus Workshop

  

   Present at your own or other department meetings.

 

   Provide written materials for faculty/staff/administrators that will be housed in

    the Center for Teaching and Learning and/or made available electronically.

 

    Other – Please specify.


*               *

Applicant Signature                                                    Date

 

The Vice President for Academic Affairs, the Associate Vice President for Academic Affairs and the LASC coordinator will be responsible for final approval of applications for funding. Recommendations from the LASC advisory board will be taken into account in the decision-making process. Given the limited funds available and in an effort to spread the funds across faculty members, departments, centers and offices to ensure broad campus involvement, funding requests under $1,000 will be given preference.