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.
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