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Professional Development Activity Approval - Franklin West Local Standards Board
Name: ______________________________________ Position: ______________________
School: _______________________________ Level: ____ License Expiration Date: _____
Endorsement(s) held: _________ Endorsement(s) to which this activity applies: _________
Please check the activity for which you are requesting (#) _____ re-licensing credits.
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______ Academic Course
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______ Workshop/Training/Conference/Seminar
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______ Designing/developing/ presenting/teaching courses, workshops, conferences
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______ Applied experience in content area through employment, internship, educational travel, or volunteer service
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______ Local school/district or state activities or action research/reform projects
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______ Institutions of higher education reform - Partnerships with K-12 schools
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______ Educational research and publication
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______ NBPTS certification program
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______ Industry credentials (e.g. EMT or CDL add-ons)
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_____ Mentor to a new teacher
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______Clinical CEUs for other required professional licenses
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_____ Peace Corps experience
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______ School-business/industry or community partnership initiatives
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_____Other: ________________________
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Complete 1-4:
1. Name/title of activity: _______________________________________________
2. Sponsoring Institution (if applicable): __________________________________
3. Expected date of completion: ______________ Anticipated hours: _____
4. How does the activity connect to your IPDP goal(s)? (attach relevant IPDP goal.)
______________________________________________________________
5. Attach a copy of course description.
For Final Approval attach appropriate documentation copies of (transcript, grade report, certificate of attendance, etc.) These will all serve as artifacts in your portfolio. Attach a description of the concepts you gained from the professional development that you plan to incorporate into your practice.
Documentation must be submitted upon completion of activity/or within one year.
The impact of this professional development upon your practice must be incorporated into the reflective narrative about your goal required as part of your portfolio at the end of 7 years.
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Educator Signature:
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# Credits
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Date
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Prior Approval:
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# Credits
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Date
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Final Approval:
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# Credits
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Date
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