PUTNAM COUNTY ESC

							                              PUTNAM COUNTY ESC
                  LOCAL PROFESSIONAL DEVELOPMENT COMMITTEE
                               ACTIVITY VOUCHER


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: _________