School Level PD Submission Form

This form is to be used for PD providers to report their activities to the Central Office for data collection and payroll purposes. Thank you for your assistance.

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* 1. Professional Development Provider

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* 2. Date of School Level Professional Development or Planning.

Professional Development or Meeting Date and Start Time

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* 3. Nature of Support

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* 4. Duration of Professional Development or Meeting. (x hrs/x mins)

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* 5. Duration of Preparation for this Professional Development or Meeting. (x hrs/x mins)

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* 6. Location of School Level Professional Development.

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* 7. Writing competencies addressed. (Select all that apply.)

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* 8. Math competencies addressed. (Select all that apply.)

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* 9. K-5 Literacy competencies addressed. (Select all that apply.)

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* 10. 6-12 Literacy competencies addressed. (Select all that apply.)

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* 11. 6-12 Graduation Success competencies addressed. (Select all that apply.)

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* 12. Program Description or Summary of Services Provided.

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