* 1. Name: Last/First

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

* 3. School/worksite:

* 4. UCDSB Employee number:

* 5. School/work site telephone:

* 6. School/work site fax:

* 7. Email Address:

* 8. Email Address confirmation:

* 9. Professional Activity:

* 10. Title of Activity or Course:

* 11. Activity Provider:

* 12. Beginning Date:

Date / Time

* 13. Completion Date:

Date / Time

* 14. Funding Request - (A maximum of $750, including the OT costs, will be provided. Please estimate other costs to their predicted maximum). 

Registration Fee:

* 15. Accommodation Fee

* 16. Car Travel: (km X $0.50)

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

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

* 19. Parking Costs:

* 20. Other Expenses: (with explanation)

* 21. Occasional Teacher Required:

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

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

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