ࡱ> OQN 0(bjbjbb |>__( rr,Dq$#######$/')$$+$'''#'#''V0"@"#w'p" #A$0q$|"x*Q:*"*"'$$q$*rX : Faculty Development Conference Reimbursement Form Please complete and submit this form and the survey form you were sent at the time of funding approval. Send original receipts. Tape small receipts onto paper. Keep a copy of your paperwork for your files. Do not send a signed requisition. Requisitions will be completed by Faculty Development. Name: ___________________________________ ID Number: Conference and Dates: ________________________________________ Office Phone #:______________ Lewis Unit#:__________________ Actual Amount Spent (with receipts)Registration & FeesAirfareRental carTaxis or shuttleParkingTrain or busCar Mileage (mi. X .580 for 2019)LodgingSubtotalPlease subtract other funding (department, grant, etc.) that you are applying to this event.Total Reimbursement Requested from University Faculty Development (up to maximum allowed for your application) Please send this completed form, your sheets of receipts and the completed funding survey, and faculty reimbursement HYPERLINK "https://lewisu0.sharepoint.com/:x:/r/sites/MyLewisPortalResources/_layouts/15/Doc.aspx?sourcedoc=%7B5052A83E-A860-4C40-8A2A-07D0A531BC8F%7D&file=Reimbursement%202024.xlsx&action=default&mobileredirect=true"form to Dr. Mallory Havens via email to havensmy@lewisu.edu Faculty Development Conference Funding Survey Please complete the following short survey and return with your receipts for funding reimbursement. The Faculty Development Committee is collecting data that describes the use of funding for faculty development opportunities. We would appreciate your response to the following questions. Name:____________________________________________ Gender:__________ Ethnicity:__________________________________ College:______________________ Department:_______________________________ Faculty Status:_____ Full Time (FT) _____Part Time (PT) Teaching Level: _____Undergraduate (UG) ______Graduate(GR) _____Both(UG/GR) Conference:________________________________________ Dates of Conference:_________________________________ Participation: _____Attendee _____Presenter _____Poster Session _____Panel Member _____Other (Please describe): Check all current university initiatives that applied to this conference: _____Student Assessment _____Civic Engagement _____Online/Blended Learning _____International/Global Learning _____Mission Development _____Teaching Excellence _____Other (Please describe): Please comment on how your attendance at this conference will impact student learning: 123 ] ^ c d y      B C W ķķ}sfTTTT#hRhg5CJOJQJ^JaJhRh"OJQJ^Jh"OJQJ^JhgOJQJ^JhHphg>*OJQJ^JhHp>*OJQJ^JhHpOJQJ^JhRh|sOJQJ^JhRhgOJQJ^JhRhdOJQJ^JhRh|s5>*OJQJ^JhRhg5>*OJQJ^JhRhg5OJQJ^J23 ] ^      B $IfgdM$ & F^gddgdg$a$gdP$a$gdgB C W X tk $IfgdM$ & F$IfgdM$}kd$$Ifl0$" f t0644 laytdW X Y a b c n o p 4 ˹ra! *hRhg56OJQJ^J& *hRhg5CJOJQJ^JaJ#hRhd5CJOJQJ^JaJ#hRhd5CJOJQJ^JaJhX5CJOJQJ^JaJ#hRhD5CJOJQJ^JaJ#hRhd5CJOJQJ^JaJ#hRhg5CJOJQJ^JaJ hRhgCJOJQJ^JaJ&X Y a b tk $IfgdM$ & F$IfgdM$}kd$$Ifl0$" f t0644 laytdb c n o tk $IfgdM$ & F$IfgdM$}kd$$Ifl0$" f t0644 laytdo p tk $IfgdM$ & F$IfgdM$}kd$$Ifl0$" f t0644 laytd tk $IfgdM$ & F$IfgdM$}kd $$Ifl0$" f t0644 laytd tk $IfgdM$ & F$IfgdM$}kd$$Ifl0$" f t0644 laytd tk $IfgdM$ & F$Ifgdd}kd0$$Ifl0$" f t0644 laytd tk $IfgdM$ & F$IfgdM$}kd$$Ifl0$" f t0644 laytd xo $IfgdM$ $IfgdD}kd@$$Ifl0$" f t0644 laytd xx $IfgdM$}kd$$Ifl0$" f t0644 laytd 5 6 xx $IfgdM$}kdP$$Ifl0$" f t0644 laytd4 5 6 7     )      ɷݪ|oo[|I|"h$5:hc0J56OJQJ^J'jh$5:56OJQJU^Jh$5:56OJQJ^J!jh$5:56OJQJU^Jhc56OJQJ^JhRhg56OJQJ^JhRhDOJQJ^J#hRhg5CJOJQJ^JaJ& *hRhg5CJOJQJ^JaJ hRhgCJOJQJ^JaJ! *hRhg56OJQJ^J6 7 xx $IfgdM$}kd$$Ifl0$" f t0644 laytd 7 L f g yqiaa\\\\gdKQ$a$gdKQ$a$gdd$a$gdGQ@$a$gdg}kd`$$Ifl0$" f t0644 laytd  # + 6 7 8 L f g +IJ=>M[\]+12PȺvvhRh3OJQJ^JhRhdOJQJ^JhRhn5OJQJ^JhRhKQOJQJ^JhRhKQ5>*OJQJ^JhRhKQ5OJQJ^JhRhd5OJQJ^JhRhd56OJQJ^Jhc56OJQJ^Jh"56OJQJ^J.IJ=>2Pt!"#gdKQPt!"#$%&'(hRhKQOJQJ^J #$%&'($a$gdW$gdKQz+p,p-p.p1h/R 4567:pd/ =!"#$% $$If!vh#vh#v:V l t065" 5f ytd$$If!vh#vh#v:V l t065" 5f ytd$$If!vh#vh#v:V l t065" 5f ytd$$If!vh#vh#v:V l t065" 5f ytd$$If!vh#vh#v:V l t065" 5f ytd$$If!vh#vh#v:V l t065" 5f ytd$$If!vh#vh#v:V l t065" 5f ytd$$If!vh#vh#v:V l t065" 5f ytd$$If!vh#vh#v:V l t065" 5f ytd$$If!vh#vh#v:V l t065" 5f ytd$$If!vh#vh#v:V l t065" 5f ytd$$If!vh#vh#v:V l t065" 5f ytd$$If!vh#vh#v:V l t065" 5f ytd%DyK yK https://lewisu0.sharepoint.com/:x:/r/sites/MyLewisPortalResources/_layouts/15/Doc.aspx?sourcedoc=%7B5052A83E-A860-4C40-8A2A-07D0A531BC8F%7D&file=Reimbursement%202024.xlsx&action=default&mobileredirect=trueyX;H,]ą'cx2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666_HmH nHsH tH@`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List jj 7 Table Grid7:V0HH A; Balloon TextCJOJQJ^JaJ6U@6 $5: Hyperlink >*B*phcRv!R $5:0Unresolved MentionB*ph`^\q PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vj\{cp/IDg6wZ0s=Dĵw %;r,qlEآyDQ"Q,=c8B,!gxMD&铁M./SAe^QשF½|SˌDإbj|E7C<bʼNpr8fnߧFrI.{1fVԅ$21(t}kJV1/ ÚQL×07#]fVIhcMZ6/Hߏ bW`Gv Ts'BCt!LQ#JxݴyJ] C:= ċ(tRQ;^e1/-/A_Y)^6(p[_&N}njzb\->;nVb*.7p]M|MMM# ud9c47=iV7̪~㦓ødfÕ 5j z'^9J{rJЃ3Ax| FU9…i3Q/B)LʾRPx)04N O'> agYeHj*kblC=hPW!alfpX OAXl:XVZbr Zy4Sw3?WӊhPxzSq]y ( y>W 4  P( B X b o 6 #( ( X8@0(  B S  ?* RZS^* 333333333C* 112[[bbcdy8ggMN[[\]mm    ! 1 $ $ ' * &sQ 0-xpU\}Ĉh^`OJQJo(hHhp^p`OJ QJ ^J o(hHoh@ ^@ `OJQJo(hHh^`OJQJo(hHh^`OJ QJ ^J o(hHoh^`OJQJo(hHh^`OJQJo(hHhP^P`OJ QJ ^J o(hHoh ^ `OJQJo(hHh^`OJQJo(hHh^`OJ QJ ^J o(hHohp^p`OJQJo(hHh@ ^@ `OJQJo(hHh^`OJ QJ ^J o(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJ QJ ^J o(hHohP^P`OJQJo(hHh^`OJQJo(hHh^`OJ QJ ^J o(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJ QJ ^J o(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJ QJ ^J o(hHohPP^P`OJQJo(hHU\}&sQ0-x                           43 % }3('RkHp[?W$ &(3:$5:A;GQ@`wB=DKQoZ.^c_bcdW{l0{Rrcn57^|s^30jP"M$IX2.3A;dg*:DX( * @( @Unknown G.[x Times New Roman5^Symbol3. .[x Arial7..{$ Calibri5. .[`)TahomaW,|8DengXian LightI{~ LightC.,*{$ Calibri Light? |8DengXianI{~;^MWingdings?= .Cx Courier NewA$BCambria Math"1h ȇ ȇCs0# # 2Q@P ?72! xxX# Conference Reimbursement FormsheffesuHavens, Dr. Mallory A.   Oh+'0 , L X d p|' Conference Reimbursement Form sheffesu Normal.dotmHavens, Dr. Mallory A.3Microsoft Office Word@G@br@@'@@dd' ՜.+,D՜.+,X hp  'ֱ#  Conference Reimbursement Form Title 8@ _PID_HLINKS'A/Phttps://lewisu0.sharepoint.com/:x:/r/sites/MyLewisPortalResources/_layouts/15/Doc.aspx?sourcedoc=%7B5052A83E-A860-4C40-8A2A-07D0A531BC8F%7D&file=Reimbursement%202024.xlsx&action=default&mobileredirect=true !"#$%&')*+,-./0123456789:;<=?@ABCDEGHIJKLMPRoot Entry Fw'RData  1Table(*WordDocument|>SummaryInformation(>DocumentSummaryInformation8FCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q