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* 1. Name: Last/First

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* 2. I am a contract elementary teacher with the UCDSB (not on recall) and therefore a member of the ETFO-UCL.

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* 3. Is this your first or second application this school year?

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* 4. School/worksite:

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* 5. UCDSB Employee number:

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* 6. School/work site telephone:

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* 7. School/work site fax:

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* 8. Email Address:

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* 9. Email Address confirmation:

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* 10. Personal Phone Number:

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* 11. Professional Activity:

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* 12. Title of Activity or Course:

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* 13. Activity Provider:

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* 14. Beginning Date:

Date

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* 15. Completion Date:

Date

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* 16. Funding Request - (A maximum of $1000, including the OT costs, will be provided. Please estimate other costs to their predicted maximum). 

Registration Fee:

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* 17. Accommodation Fee

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* 18. Car Travel: (km X $0.61)

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* 19. Other Travel: (train/plane/taxi)

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* 20. Meal Costs: (max. $80/day)

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* 21. Parking Costs:

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* 22. Other Expenses: (with explanation)

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* 23. Occasional Teacher Required:

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* 24. I have read the Terms of Reference on the ETFO-UCL website:
http://www.etfo-ucl.on.ca/profdevfund.html :

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* 25. Required Notification: Once approved, your principal will be notified of this activity if it occurs during the instructional day.

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