INDIVIDUAL  PROFESSIONAL  LEARNING  PRE-­‐APPROVAL  FORM To  apply  for  use  of  individual  professional  learning  funds,  this  pre-­‐approval  form  should  be  submitted  to  your  principal  at  least  one  month  before  the  scheduled   activity.    (May  15  for  summer  workshops).    Approval  is  determined  by  the  Principal  and  Director  of  Professional  Learning  when  funded  entirely  by  personal  PL   funds.    If  the  cost  of  a  requested  activity  exceeds  the  individual’s  professional  learning  fund  total,  faculty  may  request  additional  funding.                                 Individual  professional  learning  funds  can  be  used  for  NESA-­‐sponsored  conferences,  subject  area  conferences,  university  course  work,  online  learning,  summer  workshops  and  seminars.     Reimbursement  includes  registration/tuition,  economy  airfare,  and  lodging  (standard  hotel  rates). Individual  professional  learning  funds  cannot  be  used  for  food  and  drink,  additional  ground  transportation  unless  previously  authorized  (e.g.:  taxi  to  Dubai  airport  would  not  be  reimbursable   unless  previously  approved),  gifts  or  souvenirs,  business  class  or  airfare  upgrades,  hotel  upgrades,  extra  luggage  or  travel  or  lodging  for  family  members  not  participating  in  the  activity.                   For  Questions,  please  see  PL  Handbook  for  details.                Faculty  may  call  Michal  Caley  at  ext-­‐  441  or  email  her  for  an  update  on  individual  funds  available.

School  Year:

1). Basic Information

Name:

Veracross   Record  No:

Date  of  Request:

All

Activity  Type

☐

NESA

☐

Conference/Workshop

☐

Coursework

☐

Webinar/Other

ES

MS

2015-­‐2016

HS

Activity  Description: Organization: Activity  Start  Date:

Completion  Date:

Activity  Location: (City,  State,  Country)

☐

IB™

Total  Number  of  Days  Off  School:

(Requires  separate  IB  Request  form)

Substitute  Needed?

2). Goal Alignment and Sharing Identify  Goal  Area  Supported  by  this  PL  Request  (Please  check  or  describe) A  Goal  Area  may  be  a  School  Goal,  Division  Goal  or  Individual  Professional  Goal  (only  one  area  need  be  identified). School  Goals  (  5-­‐year  Strategic  Plan)

☐

Curriculum  Design/Review

☐

Standards  Based  Teaching  and  Learning

☐

Assessment/  Use  of  Data

☐

Distributed  Leadership

☐

Technology  Integration

☐

ACS  Core  Values/Service  Learning

Division  Goals

Individual  Professional  Goals

Identify  Goal  Area  (if  different  from  School  Goal  Area):

Identify  Goal  Area  (if  different  from  School  or  Division  Goal  Area:

Community  of  Learners:    How  will  you  share  your  learning  from  this  Professional  Growth  experience  with  your  colleagues?    (Please  describe  sharing  plan:)

Please Check All That Apply:

☐

I am willing to lead/facilitate a University of ACS mini course.

☐

I am willing to lead/facilitate a TTT Session

☐

I am willing to lead/facilitate a Lunch and Learn

3). Total Cost and Approval Current Individual PL Balance

Additional Amount Required to Fund Activity

Required  Signatures:

Director  of  Professional  Learning

AED

Estimated Cost of Activity

AED

☐

Principal

AED

I am Requesting Additional Funding.

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INDIVIDUAL  PROFESSIONAL  LEARNING  PRE-­‐APPROVAL  FORM-­‐  CONTINUED Please  attach  quotes  related  to  expenses  below.    Quotes  may  be  in  the  form  of  internet  websites,  screenshots,  emails,  etc.,  but  please  attach  a  printed  copy.     If  quote  from  the  website  is  in  currency  other  than  UAE  Dirhams,  attach  a  copy  of  the  conversion  from  www.xe.com/currencyconverter/  but  indicate  the  actual  currency   listed  on  the  quote  for  each  category.    All  quotes  should  be  in  Dirhams,  not  US  dollars. 4). Quotes  EXPENSE  DETAIL

AMOUNT

CURRENCY  AND  RATE Currency  Exchange  Rate:

Registration  Fee Currency  Exchange  Rate:

Airfare/Travel                                               Currency  Exchange  Rate:

Hotel/Lodging Expense  Other,  please  describe.

Currency  Exchange  Rate:

Expense  Other,  please  describe.

Currency  Exchange  Rate:

Expense  Other,  please  describe.

Currency  Exchange  Rate:

PREPAID

USD  to  AED  =*  3.67

-­‐>

YES

AED

-­‐>

IB

AED

-­‐>

NESA

AED

-­‐>

Group  Travel

AED

-­‐>

NO

AED

-­‐>

AED

TOTAL  ESTIMATED  COST

AED

<-­‐

Should  match  Estimated   Cost  of  Activty  from  page  1

5). Request for Additional Funding Your request will be reviewed by the PL Committee to determine level of supplemental funding. Decisions are based on the evidence provided below and amount of available funding. Please see PL Handbook for tiered rubric.

Please provide detailed evidence of…

To be completed by PL Committee

School Alignment to Priorities, Goals, and Improvement Efforts.

Potential for impact on Improved Student Performance Through Use of New Knowledge or Skills.

The Committee has determined funding of

% for this activity.

By signing this form, I agree to pay any out-of-pocket expenses that exceed the approved amount of this activity.

Faculty/Staff Signature

PL Committee Member Signature Page 2 of 2: see other side