Middlesex Community College

Professional Development Proposal Application

For Stipend for Guest Speaker On-Campus

It is recommended that applicants discuss or review their professional development proposals with their division dean or department supervisor before submitting their application.

Date of Submission:

Name:

Job Title:

Department or Division Name:

Supervisor:

Campus and Building Location:

Phone Extension:

Full Time or Part Time?

Full Time    Part Time

Date of Hire (month/year):

Proposed Activity or Project - Name of activity, course(s), conference, date(s) and location:

Purpose of Activity or Project, including the relationship to the college's strategic directions - 1 to 3 paragraphs:

Anticipated Outcome and Follow-up:

For Stipend for Guest Speaker On-Campus

Presentation Topic:

Speaker's Name:

Speaker's Credentials:

Time and Location of Presentation:

Fee:

Travel Expense:

Total Amount Requested: