STIPEND REQUEST FORM





Please make sure to have a Professional Development Plan on file before submitting a Stipend Request. Also, if you would like a copy of your transcript before submitting a request, please email us at bccdfd@gmail.com.

Your Name (required)

Butler ID Number (required)

Your Email (required)

Division (required)

Site (required)

I have reviewed and agree to the requirements found HERE
 Agree

If you are submitting hours from a Dean’s Approval and we do not yet have that form, please find it here.
Once that is completed you may continue to submit a stipend request for those hours.

Name of Activity Date of Activity (mm/dd/yyyy) Points

If you are submitting more than one form, you only need to fill out the questions once.

How do these activities fit into my professional development plan? (required)

What did I learn from participating in these activities? (required)
This might be a really significant point or two or it might just be a general impression of the material.

How will your participation in these activities improve or enhance what you are doing in the classroom or benefit you as a person? (required)

How will your participation in these activities benefit the college? (required)