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PD Funding Form v2

Information
The Alberta Home Visitation Network Association (AHVNA) will provide funding for the time spent on designated Professional Development (PD) training This form will be used to determine eligibility for PD time at a rate of $17.50 per hour. If the Early Childhood Educator is determined eligible upon confirmed completion of required hours and completion of this form AHVNA will issue a cheque.

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Training: Kimochis Virtual Aug 23rd
Course Hours: 12 hrs
Date: Aug 23rd
Location: Zoom

FOR INTERAL USE ONLY
Date: _____________________________
Cheque #: _________________________
Amount: __________________________
Initial #1: _______ Initial #2: ______

Personal Mailing Address
First time attending this training?
Ages you work with primarily?

Declaration

The following conditions apply to this PD form:

  1. The PD funds are not approved until the training has been completed, and hours have been confirmed.
  2. Prior to having fully completed the hours committed, there is no agreement between the parties, and the Alberta Home Visitation Network Association has no obligation to provide the PD funds.
  3. All information contained in this form is true and accurate.
FOIP Declaration:
All information provided by the parties will remain private and confidential.
Clear Signature
Signature of the Person Submitting this Form
Name of the Person Submitting this Form