Ivy Tech Community College of Indiana Sellersburg In-Service Request
Employee Name Date                             Last                                First                                Middle Initial
Activity Date
Activity Title/Description (Attach brochure, professional development request, etc.)
Provider
1.	Explanation of need to be addressed
2.	Explain how activity will meet need expressed
3.	Expenses

Cost of Activity	$
Lodging	$
Travel (air fare, mileage, per diem, etc.	$
Substitute Employee Expense	$
Other Costs	$
Total	$

Review/Approval Process

Routing	Initials	Date
Employee Supervisor
Functional Administrator
Meets In-Service Objective Number
Human Resources
Chancellor

After activity has been approved:
Travel requests (allow 2 weeks), registration fee payments, etc. will need to be coordinated through the Business Office.