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PENN STATE BRANDYIWNE
Professional Development Request

Name:
e-mail Address (required):
College:
Division/Department:
Brief description of support requested:
Brief explanation on how this proposal fits into your career goals. Indicate with whom you have discussed this proposal (DAA, Division/Dept. Head, Assoc. Dean, etc.)
Priority of Importance (If more than one request is submitted, rank this request relative to others you anticipate.)

Itemized Budget
Item 1 $  
Item 2 $
Item 3 $
Item 4 $
Item 5 $
Total Amount Requested: $

Have you requested support or do you plan to request support from sources outside campus?
You must select Yes / No for the following external souces for this form to be processed.
   
Outside sources requested (required). Yes | No
   
University College (required) Yes | No
Amount Requested: Amount Approved:
 
College (required) Yes | No
Amount Requested: Amount Approved:
   
Department (required) Yes | No
Amount Requested: Amount Approved:
   
Outside Agency (required) Yes | No
Amount Requested: Amount Approved:
   
Other (required) Yes | No
If 'other' selected, please explain: