Degree and Certification Program Fund Request Classified Professional Development

Degree and Certification Program Fund Request

Classified Professional Development

This request form is for

advanced studies degree and certification programs only.

Departments are not eligible for reimbursement.

Classified professional development funds are for employee's out-of-pocket expenses

Can your department provide any funding?*

Program type*

Degree program

Certification program

L Number*

First and Last Name*

E-mail address*

Mailing Address*

Please provide your home mailing address. Finance will not route checks through inter-office mail.

Department*

Job Title*

FTE Status*

1.0

.50 - .99

Less than .50

Have you completed your initial trial service?*

Yes

Not sure

Program Start Date*

When will the degree or certificate be awarded?*

Term Length*

Quarter

Semester

Other

How many terms will you attend?*

Location*

Is this online or in person?

Name of the Institution*

Name of Degree or Certificate Program*

Link to program information*

List of Required Classes*

Please list classes by number and name, e.g. BA 211 Financial Accounting; BT 291 Operations Management, etc.

Expense Breakdown & Total*

Please list tuition, book, fee breakdown and total per term that you are requesting.

List each month/year you will seek reimbursement*

For budgeting purposes, please share when you anticipate receiving grades and requesting reimbursement each term/quarter, e.g. Sep 2024, Jan 2025, Apr 2025, etc.

Program Description*

Tell us about the program and what you plan to gain from participation.

Relevance and Value*

Will this benefit you and LCC in your current position? If so, how?

Additonal information

Classified Professional Development Policy*

I have read and understand the Classified Professional Development Rules https://inside.lanecc.edu/cpdt/classified-professional-development-reimbursement-programs

College Online Policy and Procedure System (COPPS)*

I have read and understand (COPPS) https://inside.lanecc.edu/copps/documents/travel-or-expense-reimbursement

Employee Agreement*

For activities that occur during my normal working hours, I have made arrangements with my manager and they have authorized my attendance.

Send me a copy of my responses

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