"P/CZD/2 %o2-2d3

REQUEST FOR LINE OF DUTY LEAVE
I. COMPLETE THE TOP PORTION AND SUBMIT TO PAYROLL FOR PROCESSING OF LEAVE HOURS USED.
FLORIDA 2. UPON RETURN FROM TAVEL COMPLETE THE BOTTOM PORTION OF THE 2"" PAGE AND SUBMIT TO ACCOUNTS PAYABLE
STATE COLLEGE FOR REIMBURSEMENT OR TO THE BUSINESS OFFICE FOR PROCESSING.
•l
DATE

PID 4536
NAME Will.ace

R.
Middle
PERIOD LEAl/§ _.AOT AL WORKING HOURS
FROM: --Bam... -. _s_ ...-.lQ_ __ll_
TIME MONTH DAY YEAR
THROUGH: l.;12pn _5_ ____ill_ 12
TIME MONTH DAY YEAR
NATURE OF MEETING: Florida O::cncil of l(XJ
DESTINATION
LOCATION
APPROXIMATE COSTS
0 NO REIMBURSEMENT REQUESTED
IKJ ACTUAL EXPENSES
0 STANDARD RATES
TRAVEL !{]?. ?0 PER DIEM
(CITY & STATE)
LODGING 11142,72
MEALS 6.CO REGISTRATION ___ _
OTHER (Description and Amount) ________ _
TOTAL 1,550.92
BUDGET TO BE CHARGED _ _c:lco:6lc:cl:::20
00
/'-'0£"'U"-'JJ"'3'-------
POSITION NUMBER
DEPARTURE TIME
Sam
DATE 5/16/12

0 PROFESSIONAL
0FACULTY
0CAREER
THlS LEAVE FORM REPLACES LEAVE
FORM DATED _______ _
REASON FOR REPLACEMENT:
BENEFIT TO COLLEGE
ParticiiBtion will permit visibility for the
College's 183dershiD, progranE, and concerns at
the national level.
£) . M)
SIGNATURE OF PER Cl AsSUMIN<f"p&IEs
s::- <f-;J...
DATE
APPROVAL
IMMEDIATE SUPERVISOR DATE
(S1JPERVISING '??MINISTRA TOR
\ i ! .
\'
1
11 !..---· ' ( ..
DATE
BUBGET ADMINISTRATOR DATE
APPROVAL INTERNATIONAL TRAVEL
PRESIDENT DATE
RETURN TIME
7·30pm
DATE 5/18/12
PER DIEM AUTO INCIDENTAL EXPENSES PREPAID
DATE OR MILEAGE
(P-CARD, A VIS, REGISTRATION FEES, ETC_)
MEALS CLAIMED
I
AMOUNT TYPE AMOUNT TYPE
5/16&17 1,142. 72 v hotel
5/18 18.00
v'
taxi
5/18 402.20
v
Delta
TOTALS $ $ $
1,562.92
$
$
GRAND TOTAL
$ 1,562.92
I HEREBY CERTIFY OR AFFIRM THAT ABOVE EXPENSES WERE ACTUALLY INCURRED BY ME AS NECESSARY TRAVELING EXPENSES IN THE
PERFORMANCE OF MY OFFICIAL DUTIES, AND MEALS OR LOD ING INCLUDED IN A CONFERENCE OR CONVENTION REGISTRATION FEE
HAVE BEEN DEDUCTED FROM THIS TRAVEL CLAM, AND THAT S CLAIM IS TRUE AND CORRECT IN EVERY MATERIAL MATTER AND SAME
CONFORMS TH REQUIRE OF ltnA
PAYEE DATE !liJt?ji,Z OFFICE LOCATION _ _:17f/c_ __
PURSUANT TO SECTION II2.06I (3) (a), FLORIDA STATUTES, I CERTIFY OR AFFIRM THAT TO THE BEST OF MY KNOWLEDGE THE
ABOVE TRAVEL WAS ON OFFICIAL BUSINESS OF THE FLORIDA STATE COLLEGE AND WAS PERFORMED FOR THE PURFOSE(S) STATED ABOVE.
APPROVED ___
(SUPERVISING ADMINISTRATOR)
DATE-----------
FOR ACCOUNTING USE ONLY
DATE I
SOCIAL SECURITY NUMBER
I
ACCOUNT NUMBER
I
I I I
HR (096) (03!10) WHITE (original) -PAYROLU HUMAN RESOURCES- PERSONNEL flLE COPY
YELLOW- ACCOUNfS PAYABLE- 2"
0
PAGE
PINK- SUPER VISOR
GOLDENROD ·EMPLOYEE
VOUCHER NUMBER
I
AMOUNT
I
Fla. Stat. 119.071(5)(b)
The Florida Council of 100
Spring General Membership Meeting
May rB, 17 & 18, 2012
Willard Intercontinental Hotel, Washington, D.C.
AGENDA
WEDNESPAY MAY 16.2012
5:00p.m. NEW MEMBER ORIENTATION Douglas Room
Welcome all new members and their spouses in ro the Florida Council of 100.
6:00p.m.
7:00p.m.
Sponsors, former chairs and their spouses are also invited.
RECEPTION Courtyard Breezeway
DINNER Crystal Rbom
Steve Halverson, Chair
THE HON. OON GAETZ, PRESIDENT-DESIGNATE, FL SENATE
THE HON. BILL NELSON, U.S. SENATOR
THURSDAY, MAY 17,2012
7:00a.m BUFFET BREAKFAST Ballroom
7:50a.m. WELCOME Ballroom
Steve Halverson, Chair
8:00a.m. The Honorable Marco Rubio, U.S. Senator
8:45a.m. BREAK
9:00a.m
10:15a.m.
11:00a.m.
Economic and Education Competitiveness: Common Core Standards
Robert l. Corcoran, President & Chairman, GE Foundation
William Schmidt. Distinguished Professor, Michigan State University
Jason Zimba, Co-Founder, Student Achievement Partners
Kelli Wells, Program Director, U.S. Education, GE Foundation
Common Core Discussion:
Moderator: Kathleen Shanahan, Chair, FL State Board of Education
Arne Duncan, U.S. Secretary of Education
Energy Roundtable
Introductions:
Mark Crosswhite, President & CEO, Gulf Power Company
Jason Grumet Founder & President, Bipartisan Policy Center (BPC)
Byron L Dorgan, Co-Chainnan, Energy Project, BPC;
Fonner U.S. Senator, North Dakota
Randall E Davis, Principal, Stuntz, Davis & Staffier. P.C.
Energy Roundtable Discussion:
Moderator: Syd Kitson, Chair, Energy Policy Task Force, FC100
11:50 a.m. BREAK
Fla. Stat. 119.071(5)(b)

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