Prior Approval GROUP ACTIVITY

							LEON COUNTY SCHOOLS                                                                                                             LCS-9844-1148

Staff Development Department                                                                                                            White
11/24/2010

                                                                Request for
                                                 Group Activity Prior Approval (for Credit)

I. Credit Contact ________________________Contact Phone # ____________________Request Date: ____________________
      School/Group _______________________# of Participants____________ Target Audience: Administrators, Teachers, Support Staff
      Activity Title ___________________________________ Master Plan Component: _______________ Objectives: ____________
      Activity Date(s)________________________________ Follow-up Dates: _______________________Hours of Credit _________
      Presenter(s)/Trainer(s) _______________________________________ Location of Training: ___________________


Check the area this activity relates to:
 _____Subject Content          _____Teaching Method       _____Technology         _____Sunshine State Standards        _____Assessment
 _____Data Analysis            _____Classroom Mgmt        _____School Safety      _____Family Involvement


II.     What student data or state mandate led you to select this training? SIP Goal: _____________

       _________________________________________________________________________________
       _________________________________________________________________________________
       _________________________________________________________________________________
III.    What research or past success is evidence that this training positively impacts student performance? ___________________

        ____________________________________________________________________________________________________

                                                         Training Component – Initial Training


IV. Learning Method: (Circle One):
        (A)   Workshop/Activity            (C)     Electronic, Non-Interactive                (F)   Independent Study (ex: Action Research)
        (B)   Electronic, Interactive      (D)     Learning Community/Lesson Study Group      (G) Structured Coaching/Mentoring


V.       Activity Description:
       ___________________________________________________________________________________________
       ___________________________________________________________________________________________
       ___________________________________________________________________________________________


VI.      Describe the learning outcomes expected for the participants as a direct result of participating in this activity.
       ___________________________________________________________________________________________
       ___________________________________________________________________________________________
       ___________________________________________________________________________________________


VII.     Participant Assessment - Intended assessment documentation (Check one)

        _____ Lesson Plans                          _____ Action Plans                              _____ Skills Checklist (must be attached)
        _____ Reports                               _____ Products                                  _____ Written Reflections
        _____ Case Study                            _____ Other-Please Describe ________________________________________
LEON COUNTY SCHOOLS                                                                                                     LCS-9844-1148

Staff Development Department                                                                                                    White
11/24/2010



                                                                                                               Please continue on the back
                                                Training Component – Follow-up
                                 (Plan for extending and supporting the learning from the initial training)

VIII.    Implementation Method – (Circle one)
    M.   Structured Coaching /Mentoring (may include direct observation, conferencing, oral reflection, and/or lesson demonstration
    N.   Independent Learning/Action Research related to training (should include evidence of implementation)
    O.   Collaborative Planning related to training, includes Learning Community
    P.   Participant Product related to training (may include lesson plans, written reflection, audio/videotape, case study,
          samples of student work)
      Q. Lesson study group participation
      R. Electronic interactive
      S. Electronic non-interactive

      Describe how the follow-up activity will occur.
      _______________________________________________________________________________________________________

      _______________________________________________________________________________________________________

      What web-based resources will be provided? Research links, etc.) ____________________________________________

      ________________________________________________________________________________________


IX.    Evaluation Method (Students): Circle the primary way teachers will monitor the impact of the new strategies on student
       learning.

       A.   Results of district-developed/standardized student test           D.   Observation of student performance
       B.   Results of school/teacher constructed student test                E.   N/A
       C.   Portfolios of student work                                        F.   Other performance assessment
                                                                              G.   Student outcomes not evaluated


IX.     Evaluation Method (Staff): Circle the primary way teachers will be evaluated on impact of new strategies on teaching
        practices.

       A.   Changes in classroom practices                              D.    Other changes in practices
       B.   Changes in instructional leadership practices               Z.    Staff outcomes will not be evaluated
       C.   Changes in student services practices

Describe how the data will be analyzed and shared.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Please note: Credit will be awarded after skills have been implemented in the classroom, follow-up activities have occurred, impact
has been documented by individual teachers and results have been reported to the workshop contact or trainer.

X.    Activity Evaluation (Please check the evaluation form to be utilized).

                 ___ Staff Development Evaluation Workshop Form              ____ Other


Signatures
Principal/AP/ Supervisor _________________________ TEC Rep/Committee Chairperson _________________________
LEON COUNTY SCHOOLS                                                                                     LCS-9844-1148

Staff Development Department                                                                                    White
11/24/2010

                                          TEC/Staff Development Use Only

Approved _____________ Not Approved _______________ Reason: _________________________
   ______________________________________________________        ________________
                        Staff Development Office                       Date



           Submit the completed form to Staff Development. The credit packet will be sent to the Credit Contact.