Professional Development Application “Lifetime” Professional Development Application Professional Development Application Date of Application*First Name*Last Name*Employee NumberDepartmentEmployment Status--Permanent (Full-Time)Permanent (Part-Time)Non-Permanent (Full-Time)Non-Permanent (Part-Time)Special Project (Full-Time)Special Project (Part-Time)RetiredEmail Telephone (Work)Amount of Request*Please enter a number less than or equal to 1000.Type of Request*Credit CourseNon-Credit CourseWorkshopConference/SeminarComputer/Device Purchase (Taxable)Description of Request*Activity Start Date Date Format: DD slash MM slash YYYY Activity End Date Date Format: DD slash MM slash YYYY Location of ActivityRelevance of Request*Please explain how this activity or purchase relates to your work.BalanceCommentsThis field is for validation purposes and should be left unchanged.