Short Form Application Form
Professional Development Funds

Important Notes - Please Read Carefully:

• IMPORTANT: Due to the increased demand for funds, there is now a cap of $1300.00 per person for the academic year. The cap includes any funds that you may be awarded this fiscal year through professional development funds.
  
  
• IMPORTANT: You can only submit one short form per fiscal year. If the total of your purchase exceeds more than $100.00, you can only be reimbursed up to $100.00.
  
  
• You only need to turn in this one short form application (no copies are needed for the short form).
  
  
• The short form application should only be used for purchases (such as books, materials, etc.). These purchases must pertain directly to your job duties at the College. If you are attending a conference, workshop, or other event and the registration fee or other expenses are under $100.00 you must still complete the conference application.
  
  
• Do not attach your receipts with this application. You will submit your receipts to the Business Office after you receive notification of your award amount via inter-campus letter from the Office of Faculty & Staff Development.

Please complete the below application form,
then click on the "CONTINUE -->" button.

Name:
Department:
Home Phone or Campus Extension:
Home Address:
E-mail Address:
Employment Status:
	Full-time
	Part-time
Employment Type:
	Faculty
	Staff
Questions:
Please indicate the purchase you intend to make.
If it is not obvious how this purchase relates to your professional responsibilities at NECC, please provide a brief description.
Anticipated Costs:
TOTAL AMOUNT:
TOTAL AMOUNT REQUESTED:
Have you received funding in the prior or current fiscal year:
	Yes
	No

Before clicking on "Continue", please read this important message:

REMINDER: When you click on the "Continue" button, the application DOES NOT get submitted electronically to the Office of Faculty & Staff Development.

You MUST print out the completed application that appears on the next page (only one copy of the short form application is needed) and forward it to the OFSD no later than 4:00 p.m. on the deadline date.