TEANECK PUBLIC SCHOOLS	Date Received PROFESSIONAL DEVELOPMENT REQUEST
FORM 2024-2025

PLEASE TYPE OR PRINT CLEARLY. COMPLETE THIS FORM WITH ALL THE INFORMATION REQUIRED AND FORWARD TO THE OFFICE OF CURRICULUM & INSTRUCTION. INCOMPLETE FORMS WILL BE RETURNED AND MAY DELAY THE APPROVAL PROCESS. BOARD APPROVAL IS REQUIRED FOR ALL PDREQUESTS. EMERGENCY REQUESTS WILL BE REVIEWED ON A CASE BY CASE BASIS.THE REQUEST MUST BE SUBMITTED TO CENTRAL OFFICE 45 DAYS PRIOR TO TRIP DATE.

Date of Request: __________________________

Name: ______________________________________________	Position/Grade Level: ______________________

School Location and/or Department: ______________________	Substitute Required     Yes  No 

ONE MONTH PER FORM

Date: _______________                    Full Day                                             Half Day (AM)                                 Half Day (PM)  Date: _______________                    Full Day                                             Half Day (AM)                                 Half Day (PM) 

1. Conference or Visitation Place: __________________________________________________________________________________________________________

2. Sponsor of Conference (Organization Name, No Abbreviations) Purchase Order should be payable to? ________________________________________________________________________________________________________

3. Location of Conference: __________________________________________________________________________________________________________

4. Please describe your rationale for requesting this Professional Experience and how it will impact Student Achievement: __________________________________________________________________________________________________________

__________________________________________________________________________________________________________

M
Expenses: Per GSA Guidelines, http://www.gsa.gov/portal/content/104877 ileage is paid at .47 per mile. The starting point is always
your school. Please attach a copy of the MapQuest directions when requesting reimbursement.
	**A copy of your
	
registration form must be attached if requesting payment of the registration fee.

1.	**Registration Fee: __________________ 2.	Mileage @.47 per mile: _______________ 3.	Tolls: _____________________________ 4.	Airfare: ___________________________

5. Lodging per GSA: ____________________ 6. Hotel Tax:__________________________ 7. Meals per GSA:_____________________ 8. Other (taxi, parking, etc.): ____________

TOTAL: $___________________

A requisition/PO for the estimated cost of the request must be processed prior to the conference/workshop/seminar. Please make sure your calculations are correct. No changes/additions can be made to this form.

Requisition #: 	                Purchase Order #: 	

Employee Signature: 	                  Date: _____________________ BY REQUESTING THIS PROFESSIONAL DEVELOPMENT,IUNDERSTAND THAT IMAY BE CALLED UPON TO PRESENT
WHAT IHAVE GAINED FROM THIS PDTO MY SCHOOL AND DISTRICT COLLEAGUES.

Requests for reimbursement can only be processed if submitted to the Board Office within 30 days of return.
Keep copies of your receipts, send the originals, e.g., mileage, tolls, etc. and a completed Expense Report to the Board Office.
Send a copy of your Attendance Certificate given by the Sponsor of the Conference with a completed Accountability Form summarizing the professional activities and workshops/seminars attended to the Office of the Superintendent within 5 days of return.

BUDGET ACCOUNTS AND AMOUNTS TO BE CHARGED:

Account Number

Building/Department: ___________________________________________

Grant: _______________________________________________________

Substitute: ____________________________________________________

Amount

_______________________

_______________________

_______________________

ADMINISTRATIVEREVIEW

Number of days absent to date:	PI______	PB______	FT______	FI______	PD______

PRINCIPAL APPROVAL/DENIAL:

Circle One:	Approved	Denied

Reason for Approval/Denial: __________________________________________________________________________________________________________

Principal Signature: __________________________________________

DIRECTOR APPROVAL/DENIAL:

Circle One:	Approved	Denied

Reason for Approval/Denial: __________________________________________________________________________________________________________

Director Signature: ________________________________________________

ASSISTANT SUPERINTENDENT APPROVAL/DENIAL:

Circle One:	Approved	Denied

Reason for Approval/Denial: __________________________________________________________________________________________________________

Assistant Superintendent Signature: ________________________________________________

BUSINESS ADMINISTRATOR APPROVAL

Business Administrator Signature: ________________________________________________

Date: ____________________________

APPROVAL OF SUPERINTENDENT

Circle One:	Approved	Denied

Reason for Approval/Denial

__________________________________________________________________________________________________________

Signature: _______________________________________________

Board Approval Date: _________________________________	Revised: September 2023