ࡱ> 02/Y bjbjdd . bb    $KMMMMMM$zxqqKK"70(qq B b: BEMIDJI STATE UNIVERSITY PROFESSIONAL IMPROVEMENT FUND Application for MSUAASF Employees NAME ____________________________________________ DATE _________________________ DEPARTMENT _______________________________________________________________________ PERIOD FOR WHICH GRANT IS REQUESTED __________________________________________ NAME OF CONFERENCE, WORKSHOP, ETC. ___________________________________________ LOCATION OF EVENT ________________________________________________________________ DATE OF EVENT _____________________________________________________________________ 1. Describe the program for the purpose of professional improvement, employee development, staff training or related program which you intend to pursue. (If space is insufficient, please use another sheet.) _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 2. Itemize Funding: Amount Explanation Tuition/Registration $ _________ ________________________ Fees _________ ________________________ Transportation _________ ________________________ Lodging _________ ________________________ Meals _________ ________________________ Equipment & Supplies _________ ________________________ Other (Specify) _________ ________________________ TOTAL $ __________ ________________________ 3. Explain how this training will benefit you and the institution in your subsequent work. _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 4. Number of years of service at this University: (Including this year) _____________________________________________________________ Highest degree held _____________________________________________________________ 5. Have you ever received an improvement grant before? ________________________________ If so, when, and for how much? ___________________________________________________ Purpose of former improvement grant _____________________________________________ _______________________________________________________________________________ _____________________________________ ______________ Signature of Applicant Date ____________________________________ ____________________ ______________ Signature of Supervisor Recommendation Date Please be advised that members awarded a PIF grant are required by contract to provide a final report of the activities within 30 days of the activity. PIF COMMITTEE Funded $____________________ Not Funded ____________________ hk`h 5CJ\hk`5CJ\7YZ  V W O P ! q r   d e ` 0^`0$a$   W X "#PQ#$[\`IJ?@lmnoSvwxy,1h/ =!"#$% s666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontViV 0 Table Normal :V 44 la (k ( 0No List PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w<     8@0(  B S  ?x  33  I>2Sk` @ @UnknownG*Ax Times New Roman5Symbol3. *Cx ArialA$BCambria Math"1hII  !20 3qHP $P 2!xx BEMIDJI STATE UNIVERSITYUser Gwen BaileyOh+'0p   , 8 DPX`hBEMIDJI STATE UNIVERSITYUserNormal Gwen Bailey2Microsoft Office Word@@1@1 ՜.+,0 hp  91̽  BEMIDJI STATE UNIVERSITY Title  !"#$%&()*+,-.1Root Entry F31TableWordDocument. SummaryInformation(DocumentSummaryInformation8'CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q