Combined School Form (Professional Leave/use Of School Facilities/fund Raising Activity)

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RETURN TO: Asst. Superintendent for Administration
TAZEWELL COUNTY PUBLIC SCHOOLS
209 W. Fincastle, P.O. Box 927, Tazewell, VA 24651-0927
TODAY’S DATE: ______________ FROM: ______________________________ at _____________________________________
(name of person submitting form)
(name of school)
NOTE: Please review all instructions on the reverse side of this form before submitting your request for an activity. Complete each form in its entirety (front and back.)
PROFESSIONAL LEAVE
Nature & Location of Meeting:
(Attach any printed information and where you can be reached.)
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
 Overnight Stay:  Yes
 No
 Departure - Date: ______________________ Time: ______________________
 Return
- Date: ______________________ Time: ______________________
 Who will pay expenses: (Check one)
_______ TCPS; _______ Self; _______ Local School; _______ State Dept.; _______ Athletic Dept/VHSL; _____ Other (Explain)
_______________________________________
SIGNATURE OF PERSON SUBMITTING REQUEST
_______________________________________
POSITION
USE OF SCHOOL FACILITIES
FUND RAISING ACTIVITY APPLICATION
FACILITY: _________________________________________
SCHOOL: ____________________________________________
Name of Organization: _________________________________
Address: ____________________________________________
ORGANIZATION:
_________________________________________
Phone: (w) ____________________ (h) ___________________
Billing Address: ______________________________________
Explain the purpose of your project.
Activity Planned: ______________________________________
__________________________________________________
Date(s) Facility needed: ________________________________
__________________________________________________
Beginning Time: ___________ Ending Time: __________
How will funds be raised?
Special Instructions, Requests, Etc: (attach information)
__________________________________________________
NOTE: Principal and party making request for use of facility will be notified by
__________________________________________________
Central Office of determination.
PRINCIPAL VERIFIED ON SCHOOL CALENDAR______
How will proceeds be used?
FOR CENTRAL OFFICE USE
__________________________________________________
Use of School: ____________
__________________________________________________
Custodial Services: _________
Fee Charged__________
How is this activity compatible with school division objectives?
No Charge: _______________
__________
________________________________________
Payment Received: _________
__________________________________________________
Date Received: ____________
TOTAL CHARGES:
Does the project support school division:
NOTE: Fees charged do not involve security, protection against vandalism, or
curricular objectives? ___________
destruction of property.
Organization or responsible party using the school
athletic objectives? _____________
facility will be held accountable.
__________________________
__________________________
(Signature of Responsible Party)
(Signature of Responsible
Party)
_______ REJECTED _______ APPROVED
____________________________________________________
__________________________
PRINCIPAL
DATE
_______ REJECTED _______ APPROVED
____________________________________________________
__________________________
IMMEDIATE SUPERVISOR (CENTRAL OFFICE)
DATE
_______ REJECTED _______ APPROVED
____________________________________________________
__________________________
SUPERINTENDENT / DESIGNEE
DATE

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