PROFESSIONAL DEVELOPMENT CREDIT REQUEST FORM Teacher's Name: ________________________ SS# _______________________ Date of Request: ________________________ Name of Workshop or Course Taken for Credit (outside of school calendar): ______________________________________________________________________ Topics Covered: _________________________________________________________ Date Taken: __________________________ Name of Provider / Facilitator: _________________________________ Number of Hours Credit Given by Provider: _______________________ Location of Workshop or Course: ______________________________ Date of District/Campus Inservice Day for which you are requesting non-participation: ______________________________________ Name of District/ Campus Workshop for which you are requesting non-participation: ______________________________________
Teacher's Signature: _____________________________ Principal's Signature: _____________________________ Curriculum Director's: Signature: ____________________ |