NYSTAA Professional Development Form

First name

Last name

Phone

Title

Institution Name

How many years have you been involved with NYSTAA?

Personal Statement: Describe why you are applying for the PDG? What benefit will you receive from attending the NYSTAA conference? Please also describe your previous and potential involvement in NYSTAA. This information will be used to consider your selection.

Personal Statement

Letter of Support: Provide a letter of support for your attendance at the conference from your Director or Vice-President stating that your institution is unable to pay for your attendance due to budget constraints.

Letter of Support

Describe your plan/goal on how you intend to give back to NYSTAA if awarded this grant. Examples include, but are not limited to, committee membership, conference workshop presenter, board member.

Provide the following additional information in the event that you are awarded a grant.

If you plan to share your room with anyone please list them below.