DMJ 2017/2018 PD Request Form
This form is to be used to request PD for June 1, 2017 - May 31, 2018
Email address
Employee Name
Your answer
email address
Your answer
Please choose your school.
Date(s) of professional development
Your answer
Time of meeting
Your answer
Professional development location
Your answer
Name of PD activity
Your answer
Presenters Name
Your answer
Number of hours
*PD full day = 6 hours
Your answer
Is this a state required PD session?
ie - Tier 1 training, Teen Suicide, Advanced Placement
Required
How does this PD activity address student achievement and the needs of the school improvement plan AND your PGP?
All PD must correlate to student achievement/school improvement plan
Your answer
How will the cost of this PD activity be covered?
Required
If other please explain
Your answer
Registration Fees
Your answer
Lodging Expense
Your answer
Travel/Mileage Expense
.35 X miles round trip = $mileage reimbursement
Your answer
Meal Expense
meals are only reimbursed if overnight stay is involved.
Your answer
Total PD activity expense
Enter the total expense of the workshop by including all expenses listed above.
Your answer
I understand if I register for a workshop and do not attend or leave the district I am responsible for reimbursing the school for the expense of the workshop.
Required
Restrictions are placed upon the use of Federal funds for the state required 36 PD hours. I understand that if Federal funds are used to pay for the PD then those hours earned cannot count towards my state required PD hours.
Required
Please complete the captcha before submitting the form.
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