PUTNAM COUNTY ESC
LOCAL PROFESSIONAL DEVELOPMENT COMMITTEE
Complete this section for preapproval of activities.
List one activity per page. Make copies of this form as needed.
Name _____________________________ Building _______________________
Type of Activity __________________________________________________________
Describe the activity and how it relates to your professional development goals.
Estimate the number of hours that you plan to invest in this activity:
Attach any additional information that you think might help the LPDC to review and approve your request for
clock hours for this activity.
Upon approval, submit any work products resulting from your activity, as well as the activity log documenting
your time invested.
Educator Signature: Date:
LPDC Approval: Date:
Clock Hours Approved: _________