INDIVIDUAL PROFESSIONAL DEVELOPMENT PROPOSAL
FOR MEMBERS OF THE BELOIT COLLEGE FACULTY

PLEASE COMPLETE A SEPARATE FORM FOR EACH PROJECT YOU ARE PROPOSING OR EACH EVENT YOU PLAN TO ATTEND.

Please note that there is NO SAVE function for the online form. If you close this page before clicking submit, your work will be lost.

APPLICANT NAME:
APPLICANT E-MAIL ADDRESS:
example: joe@yahoo.com
DEPARTMENT:
POSITION: (Choose one)


APPOINTMENT: (Choose one)

ARE YOU REPLACING AN EXISTING PROPOSAL?
(If so, please enter your proposal number. This can be found in the confirmation email you received after submitting the original proposal.)


, this replaces proposal #

Choose EVENT OR PROJECT:
(Examples of EVENTS are scheduled conferences, workshops and meetings. Examples of PROJECTS include site visits and research trips.)

Is the EVENT or PROJECT being proposed as part of a collaborative effort with other groups, departments or agencies?
(Examples of collaborative efforts include site visits for the Office of International Education, conferences involving more than one department, and workshops with other ACM institutions)


, I am collaborating with:

Name of EVENT (Conference, Workshop, etc.) OR PROJECT:
Location of EVENT (Conference, Workshop, etc.) OR PROJECT:
WILL YOU BE TRAVELING INTERNATIONALLY?


DATE(S):
Begins on: select
Ends on: select
IF YOU ARE ATTENDING AN EVENT, PLEASE INDICATE IN WHAT CAPACITY YOU WILL BE ATTENDING: (Check all that apply)
(Please see the purple sheet for descriptions of how these categories are interpreted by the PPDC.)
Paper or poster presenter
Presenting exhibition or performance
Workshop participant
Organizing and/or leading event or significant aspects of event
Chair of session
Panelist or discussant
Attendee
Other (please describe)
IF YOU ARE ATTENDING AN EVENT AND PRESENTING A PAPER, POSTER, OR AN ARTISTIC PIECE OF WORK, PLEASE PROVIDE THE TITLE OF THE PAPER/POSTER/ARTISTIC PIECE.
HAS YOUR PAPER, POSTER, OR ARTISTIC PIECE OF WORK BEEN ACCEPTED BY THE EVENT ORGANIZER?



IF YOU ARE ATTENDING AN EVENT BUT WILL NOT BE PRESENTING A PAPER, POSTER, OR ARTISTIC PIECE, PLEASE DESCRIBE YOUR ROLE AT THE EVENT.
(4000 characters max.)
IF YOU ARE REQUESTING PROJECT FUNDS, PLEASE DESCRIBE THE PROJECT, INCLUDING PROJECT GOALS AND OUTCOMES. THE FUNDS YOU REQUEST SHOULD BE IN ALIGNMENT WITH THIS DESCRIPTION.
(4000 characters max.)
HAVE YOU ALREADY RECEIVED PPDC FUNDING THIS FISCAL YEAR (June 1 to May 31)?



DO YOU HAVE OUTSTANDING RECEIPTS?



PLEASE PROVIDE AN ITEM-BY-ITEM BREAKDOWN OF THE MONEY YOU ARE REQUESTING:

HOTEL      
Room Fees
$
per night

night(s)
 
Internet Access
$
total for stay
  $
HOTEL SUBTOTAL
(this field is calculated for you)
FEES      
Registration
$
in registration fees
   
Other Fee #1
(specify type of fee)
$
in other fees
   
Other Fee #2
(specify type of fee)
$
in other fees
   
Other Fee #3
(specify type of fee)
$
in other fees
   
Other Fee #4
(specify type of fee)
$
in other fees
  $
FEES SUBTOTAL
(this field is calculated for you)
COMMENTS: Please explain special circumstances that may account for higher fees.
TRANSPORTATION      
Airfare
$
in airfare charges
$
in baggage charges
 
Personal vehicle
$0.42 per mile

total miles driven
$
in personal vehicle charges
(this field is calculated for you)
 
Bus
$
in bus charges
   
Local transport
$
in local transport charges
   
Other
(specify mode of transportation)
$
in other transportation charges
  $
TRANSPORTATION SUBTOTAL
(this field is calculated for you)
COMMENTS: Please explain special circumstances that may account for higher transportation costs.
FOOD
$40/day
(receipts required for reimbursement)

days
  $
FOOD SUBTOTAL
(this field is calculated for you)

OTHER EXPENSE #1
(PPDC cannot fund miscellaneous)


(specify type of expense)

$
in other expenses
   
OTHER EXPENSE #2


(specify type of expense)
$
in other expenses
   
OTHER EXPENSE #3


(specify type of expense)
$
in other expenses
   
OTHER EXPENSE #4


(specify type of expense)
$
in other expenses
   
OTHER EXPENSE #5


(specify type of expense)
$
in other expenses
  $
OTHER EXPENSES SUBTOTAL
(this field is calculated for you)
TOTAL AMOUNT REQUESTED: $
total amount requested
(this field is calculated for you)
OTHER COMMENTS:
(4000 characters max.)

If there are special considerations PPDC needs to be aware of, please explain them here.