ST. LAWRENCE VALLEY TEACHERS’ LEARNING CENTER

106 SATTERLEE HALL, SUNY, 44 PIERREPONT AVENUE, POTSDAM, NY, 13676

Phone:   315-267-3411         Fax:  315-267-2531         Email:  tlc@potsdam.edu

Teacher Requested Professional Development Grant Application

A group of 2 or more teachers from any district or combination of districts in St. Lawrence County can request Teachers’ Center funding for professional development in their district or some other centralized location. The training needs to serve a minimum of 10 people. The Teachers’ Center reserves the right to extend an invitation to educators from other districts to attend. Applications should be submitted about 2 months prior to the scheduled event.

District: ____________________________________________________________________________

Person(s) Applying:

Name(s):___________________________________________________________________________

Address: ___________________________________________________________________________

Telephone: _________________________________________________________________________

E-mail Address: _____________________________________________________________________

Fax: _______________________________________________________________________________

 

Title and Description of Program

(Attach detailed description and/or brochure if available):

___________________________________________________________________________________

___________________________________________________________________________________

Proposed Date and Location: __________________________________________________________

Proposed Audience: __________________________________________________________________

Relationship to New York State Learning Standards:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Technology Integration (if applicable):

______________________________________________________________________________

Amount Requested from the Teachers’ Learning Center:

______________________________________________________________________________

Number of educators expected to be served (min. of 10): _________

Has your organization received funding through the Teachers’ Learning Center in the past? If yes, when, for what purpose, and how much was received?

___________________________________________________________________________________________

 

Total Proposed Budget:

Presenters’ Fees _____________________________________________________________________

Materials (please list) __________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Refreshments  ________________________________________________________

_____________________________________________________________________

Housing _____________________________________________________________

_____________________________________________________________________

 

Mileage (@ $.445/mile) ____________________________________

Other (please specify) _______________________________________________________

_____________________________________

 

REGISTRATION FEE TO BE CHARGED (if any) _______________

It is agreed, that if this program receives funding from the St. Lawrence Valley Teachers’ Learning Center, attendance will be offered to other districts and organizations served by the Teachers’ Center.

Please return this application 2 months prior to the scheduled event.

______________________ ___________________________________

Applicant(s) Signature(s) Applicant(s) Printed Name(s) and Title

______________________ ___________________________________

Applicant(s) Signature(s) Applicant(s) Printed Name(s) and Title

________________________ ___________________________________

Blding Admin Signature District Superintendent Signature

of proposed location of the program (if applicable)

 

________________________________________________________________________

 

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