SPD Request Form

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Request Form

Please take the time to fill out this form and submit it.

Today's Date
*First Name*
*Last Name*
*Email address*

Enter your department in the space provided below.

Please enter the conference name, location and date of activity.

Justification for Activity (Please address the following in the justification: How will you measure the impact on student learning?)

Itemized Budget Request
Registration Fees.........................................$

Lodging........................................................$

Transportation.............................................$

Meals...........................................................$

Miscellaneous Expenses..............................$

Total Amount Requested.............................$

Have you applied for additional funding?    Yes     No

If yes, has it been awarded?    Yes    No

Supervisor approval?    Yes     No

Note: Requests will be reviewed by the Osceola Campus SPD Committee in the order received.

Thank You

Last revised: January 12, 2005

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