Professional Development - Hiawatha Valley Education District

First Name: *

Last Name: *

Phone Number: *

Email: *

Supervisor's Name: *

Is your supervisor aware of your request: *

Yes

Event Name: *

Event Date(s): *

Event Location, including state. REMINDER - out of state travel requires approval by MDE. Contact for the MDE form: *

Attendance requested by: *

Self

Supervisor

Executive Director

Description of event: *

Registration process you are requesting: *

If approved, I will self-register and request reimbursement.

I am requesting HVED to pay for my registration cost; minimum of 30 days advanced notice required..

If there is an early bird discount, list closing date for early bird registrations.:

Please list attendance comments, if any:

How will you be traveling: *

I will use my assigned HVED RAV 4, (carries up to 5 people).

I will be requesting to use an HVED RAV 4, (carries up to 5 people)

I will be requesting to use an HVED van, (carries up to 10 people).

I will be using my personal car.

This trip requires a flight.

This is an online event and does not require travel

If carpooling, list who you will be carpooling with:

Lodging for this event: *

This event does not require lodging.

If approved, I will pay for my lodging and request reimbursement.

I would like HVED to pay for my lodging; minimum of 30 days advanced noticed required.

If requesting HVED to make lodging reservation, please list contact information for the hotel you are requesting.:

Send me a copy of the completed form to this email address *: