Faculty Fund Request

Faculty Fund Request Form 2022-2023
Name*
Your Email*
example@example.com
Date*

MonthDayYear
Date
Need ideas?

YesNo
Faculty Professional Development Funds Ideas:
- AADPRT Membership $200.00
- Academic Psychiatry $400.00
- CCPS Conference
- APA Conference:
https://www.psychiatry.org/psychiatrists/meetings/annual-meeting/registration
What is the request for?*

Professional development funds to purchase...Professional development funds to attend...Program funds for...Request to order poster to present research and/or scholarly activity
How much professional development funds?*
Description of professional development funds... *
Name of conference*
Location (City. State)*
Dates of conference*
Registration cost?*
Estimate of expenses including flight, lodging, and meals?*
How much program funds?*
Program funds description... *
Select

Purchase the item with personal credit card and be reimbursedPurchase is urgent and you want purchase to be made with Kaweah credit card instead of issuing a check
Expenses will not be reimbursed if prior approval is not received and recorded by the Office of Graduate Medical Education. All expenses submitted for reimbursement require on original, itemized receipt. All expenses shall be submitted to the Administrative Assistant in the GME Office, along with the Request for Reimbursement Form, within 30 days of the purchase. The final date to submit receipts for the fiscal year is June 10.
Signature*

Clear
Date*

MonthDayYear
Date
Ready to submit to PD?*

YesNo
All faculty are required to complete scholarly activity. Which of the following have you worked on in the last academic year or plan to work on?

Poster presentationWorkshopPresentation at regional conferenceCase report/case seriesPubMed ID publicationOther

PD use only
Program Director Signature

Clear
Send to GME?

YesNo, reject to sender
Should be Empty:

Faculty Fund Request Form 2022-2023