Send This Form To TEC � Do Not Attach To Travel Voucher

							                                                                                                                                 LCS-9844-1147

LEON COUNTY SCHOOLS
Staff Development Department
1/8/10                                                                                                                                     Yellow
                                     Send This Form To Staff Development Dept. – Do Not Attach To Travel Voucher

                                                                 LEON COUNTY SCHOOLS
                                                               TEACHER REQUEST FOR CREDIT
                                               FOR CPR, FIRST AID, CPI, OR TACT WORKSHOPS
                                                INDIVIDUAL PROFESSIONAL DEVELOPMENT FOLLOW-UP FORM



Name:________________________________ Date:_____________________ School/Group:________________________

Name of Activity: ______________________ Activity Date:______________ Location: _____________________________

Personal Identification (PID) #: _________________ Master Plan Component: __________ Objectives: ________________


              CREDIT MUST BE SUBMITTED TO STAFF DEVELOPMENT DURING THE FISCAL YEAR IT IS EARNED. (E.G. 07/01/06-06/30/07)



Delivery Method (Circle one) (A) Workshop                     (B) Electronic, Interactive          (C) Electronic, Non Interactive
                             (D) Study Group/                 (E) Action Research                   (F) Independent Study
                              Learning Community


Primary Purpose (Circle one)           (A) Add-on Certificate                (C) Florida Educators Certificate Renewal
                                       (B) Alternative Certification         (D) Other Professional Certificate/License Renewal
                                                                             (E) Professional Skill Building

     Directions:
         1. Answer ALL questions for in-service credit. Attach certificates of completion for CPR, First Aid, CPI, TACT.
         2. Principal/AP/supervisor signature OR a leave form with an administrator’s signature is required.
         3. Attach agenda circling the sessions attended. Attendance at sessions is used to determine points. Agenda is always required.


I.        How did this training relate to your Individual Professional Development Plan?



_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________

                                                                                                                            Continue on back.




     TEC/STAFF DEVELOPMENT ONLY:                                                              Number of points: ____________

     Approved by: ___________________                                                          Date: ______________________
                                                                                                              LCS-9844-1147
LEON COUNTY SCHOOLS
Staff Development Department
1/8/10                                                                                                             Yellow


II.        Is additional training required for continued certification in this area? (Circle one) Yes or NO

            If Yes, what is the anticipated date? _________________________



III.       What specific concepts, knowledge, skills, or strategies did you learn in this training?

_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________



IV. How will this training benefit your students, school or department?

_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________




  Signature:____________________________________ Title: _________________________ Date: __________________
                  (Principal/Supervisor)


                                       In lieu of a signature, an approved leave form may be attached.