Request for Pre Approval of PD Activity by D5D29A5

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									                     Local Professional Development Committee
    Request for Pre-Approval of Professional Development Activity

Name:                                         IPDP Approval Date:
License Number:                               License Expiration Date:
Work Assignment:
Work Location:
Complete Home Address:
Date(s) of Proposed Professional Development:
Location of Professional Development:
                          Type of Proposed Professional Development Activity
                                                                                        Max CEUs per
                                               Activity
                                                                                        license cycle*
                 Peer Coaching or Mentoring                                                6 CEUs
                 Shadowing, Externships                                                    6 CEUs
                 Grant Writing or Grant Reviewer                                           6 CEUs
                 Professional Committee                                                       3
Self-Directed Educational Professional Development Activities
                     Curriculum Unit                                                         6
                     Educational Project                                                     3
                     Educational Travel                                                      1
                     Peer Observation                                                        1
                     Professional Presentation at workshop or conference                     6
                     Professional Reading                                                    1
                     Publication of Original Work                                     Varies (3 to 18)
                     Research, Action Research or Inquiry                                    6
                     School, Community Partnership Initiatives                               6
                     Reflective Portfolio                                                    3
                     Reading Study Group                                                     3
Alignment to Ohio Standards for High Quality Professional Development (HQPD) (check all that apply):
                 1: HQPD is a purposeful, structured and continuous process that occurs over time.
                 2: HQPD is informed by multiple sources of data.
                 3: HQPD is collaborative.
                 4: HQPD includes varied learning experiences that accommodate individual educators’
                 knowledge and skills.
                 5: HQPD is evaluated by its short and long-term impact on professional practice and
                 achievement of all students.
                 6: HQPD results in the acquisition, enhancement or refinement of skills and knowledge.


ESC of Lake Erie West                                                          1
1/2012
                 Local Professional Development Committee
   Request for Pre-Approval of Professional Development Activity


Description of Professional Development Activity:


Connection of Professional Development to IPDP Goals:




I understand that CEU/contact hour credit will not be given for this project until I have
submitted the appropriate documentation for review by the LPDC. (See LPDC Handbook for
further information)


Signature of applicant __________________________________________ Date_____________

DO NOT MARK BELOW THIS LINE. FOR LPDC USE ONLY.


Approval Signature_________________________________________ Date________________




ESC of Lake Erie West                                                 2
1/2012

								
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