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(For Office Use Only)           

SWARTZ CREEK COMMUNITY SCHOOLS
Professional Development Activity Form

Forms must be submitted TWO WEEKS PRIOR to activity.  One participant per form.
Please attach a registration form and a signed check request (if applicable) with this form.

Teacher's Name:  Today's Date: 
District/Building:  Grade:
and/or Subject:
Title of workshop/conference:   Location:
Date(s) of workshop/conference:  
Number of hours of workshop/conference: 
  From: To:
(Excluding registration, breaks and meal times)
Six (6) hours of a conference/workshop is considered a full day of professional development (excluding registration and meal times).  According to State guideline "no more than one full day of professional development credit can be received on any given day."
Choose only one option: If 1526 hours are needed, please check that box as well.    
Section 1526  New teachers within first 3 years of employment in teaching          Literacy Coach ($200 per teacher)
Strategic Planning Goal _________________________________________         Department Specialist ($200 per teacher)
Curriculum Rotation (Subject) _____________________________________        Building School Improvement Goal

Substitute Teacher Needed:  NO  YES   From:      To:
Substitute Requested:
  
Building principals are responsible for contacting switchboard to arrange for substitutes.
Funding Source(s): Include estimate of needed funds and appropriate ASN for each area

     Registration:   ASN:       Food:  ASN:  
     Substitute:  ASN:           Other: ASN:          Lodging:  ASN:     

Signature of Teacher:  
Pre-Approval Granted: 

                                   
(Building Administrator Signature)                      (Pre-Approval Date by Office of Instruction)
CONFIRMATION OF WORKSHOP ATTENDANCE ~FOR SECTION 1526 ONLY!~
Once the workshop/conference has been completed, please sign and return this entire form to the PERSONNEL OFFICE within one week of the completed conference.  All hours will be credited once we have received this form.*
**PLEASE KEEP A COPY OF THIS FORM FOR YOUR RECORDS***

Signature of Teacher or Presenter:______________________________________________________Date:___________________________________

OFFICE USE ONLY:

COPY TO: Nan_______________  Patty_____________  Teacher______________