ATLA Professional Development Committee Grant Application

Grant for Continuing Education Programs Application Form

* indicates a required field

Name of regional group or Institutional Member sponsoring the program*

Name of any additional institutions participating*

Name of contact person for application*

	Address*

	Phone:
	Fax:
	E-mail:*

Name and address of payee (should grant be awarded)*

Title of proposed program*

Program description (include a description of program format, such as workshop, panel, or lecture, as well as basic content of program)*

Suggested presenter(s)*

	Qualifications of presenter(s)*

Intended audience

Estimated size of audience

Proposed date and location for program

Estimated Program Expenses

Please Note: Grant funds may be requested for all types of expenses related to speakers. If the speaker is a member of the ATLA staff the organization will normally cover related costs. Suggested honoraria are: full day, $400-$450, half day, $200-$250, one- to two-hour workshops, $150-$250. Please explain any deviations from the suggested honoraria in the Comments section below.

Grants are not available for individuals. Grant funds should not be requested for participants' lunch/break food expenses or parking fees. It is anticipated that grant funds may not be available to cover the total cost of a program and that the regional group may need to provide additional funding.

	Amount
Speaker expense
Travel	$
Housing/Meals	$
Honorarium	$

Other (examples: room fees, materials,equipment rental, etc.)
Item:	$
Item:	$
Item:	$
Item:	$

	$ *

Amount of Funding Requested	$ *

Questions/Comments: