Middlesex Community College

Professional Development Proposal Application

For Course Tuition/Course Textbook Support

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 Extention:

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 Course Tuition

A copy of the catalog course description, including books or other materials required, verification of tuition and fees. Note: Based on your employment status you may be eligible for tuition waivers, which can affect the amount requested/granted. Please call Human Resources (ext. 3531) for this information.

Price for Course:

Tuition Waiver Amount:

Sub-Total:

Fees:

Books:

Supplies:

Total Amount Requested: