Schick Conference Attendance Request

Schick Professional Staff Conference Request On-Line Form

Instructions to Applicant:
- Form is used by members of the professional staff seeking permission to attend conferences, workshops, etc.
- Forward information regarding conference, workshop, etc. to the Supervisor of Curriculum & Instruction.
- We recommend one person per grade level, team, or department per year to a specific conference.
- Attendee must complete the LTSD Conference Summary Report within three weeks of attendance. The form is located on the Staff Forms page.

- Notification relative to confirmation will occur no later than two (2) weeks prior to the appropriate conference.
- Upon approval, the request form will be returned to the applicant and the building administrator (upon request).
* NOTE - If requests are received with missing information, the request may be returned to the applicant for re-submission.

A Conference Reimbursement Form and appropriate receipts must be submitted to the District Service Center within three (3) weeks of conference attendance. If approved or denied any email will be sent to requestor by email used in this form.

Name *

Email *

Name of Activity: *

Location of Activity: *

Dates of Activity (From):* The value must be between 07/01/2022 and 06/30/2023, inclusive. *

mm/dd/yyyy

Dates of Activity (To):* The value must be between 07/01/2022 and 06/30/2023, inclusive. *

mm/dd/yyyy

Please describe how this conference will benefit you personally or professionally. *

Please signify if this conference attendance request is personal or initiated by the district. *

Please signify how many conferences you have attended so far this academic year.

Registration Fee *

Substitute Number of Days: *

Number of Miles *

Mileage Rate Totals (Multiply .70 by number of miles): ** Subject to IRS change.

Lodging Number of Days: *

Lodging Rate: *

Lodging Total (multiply number of days by lodging rate): *

Other (Maximum meal allowances are as follows: Breakfast- $10.00; Lunch- $15.00; Dinner- $25.00):

Total estimated expenses a maximum total dollar amount of $600, including meals, lodging, transportation, and conference fees. Requests exceeding $600 must be approved by the superintendent.

Total Conference Request: *

Your Electronic Signature *

Loyalsock Township School District requires that the parties to certify the application by submitting an electronic signature. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability and admissibility.

If you are human, leave this field blank.