School of Medicine Directors of Finance and Administration
Continuing Professional Education Matching Funds Application
Not to Exceed $1,000
(Please fill out one form for each course/seminar/conference)

Name___________________________________ Department___________________________

Mail Code_______________________________ E-Mail______________________________

Voicemail_______________________________ Fax_________________________________


Title of Course/Seminar/Conference (attach description)

Brief Description of how the Course/Seminar/Conference will apply and improve your work environment.

Date Course starts____________________ Date Course ends _____________________

Total Funds Requested $________


APPROVALS:

_______________________________________________ __________________
Human Resources Date
_______________________________________________ __________________
DFA Signature Date

Send applications to:

Cori Bossenberry, Director, HRG
MSOB XC01
MC: 5460