Clock Hour Proposal Form for Tahoma School District

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Use this form to submit a course/program for clock hour approval.This form is to be filled out by the person originating the request for clock hours AT LEAST TWO WEEKS PRIOR TO THE EVENT.

If you would like to submit a program/course/training that will NOT offer clock hours, use the Tahoma Staff Training Opportunity--No Clock Hours Offered Form (http://goo.gl/a6kyas) instead.

IMPORTANT: If your training/program requires substitutes, make sure you have already reserved the required subs through your building/department designee. The "duty out of classroom" daily sub limit for Mondays through Thursdays is 16. For Fridays the limit is 7. We strongly recommend that you reserve your subs AND location BEFORE filling out this form.

LAST name of person originating this request *

FIRST name of person originating this request *

School/Building *

Program/Course Description

Program/Course Title *

This will appear on the Tahoma Learns Calendar if you choose to make this event public.

Program/Course Description *

This will appear on the Tahoma Learns Calendar if you choose to make this event public.

Major Topics to Be Covered *

Please put each topic on its own line.

Program/Course Objectives *

Note: If the proposal is for multiple sessions, or approval is being sought far in advance, general program objectives may be submitted. If the proposal is for an individual session, then specific learning targets may be submitted.

Describe the target audience for this program/course. *

This will appear on the Tahoma Learning Calendar if you choose to make this event public.

List any prerequisites or requirements for this program/course.

This will appear on the Tahoma Learning Calendar if you choose to make this event public.

Check the student learning improvement goal your workshop will address.

Goal 1: Reading/Writing/Communication

Goal 2: Mathematics/Science/Social Studies/Arts/Health and Fitness

Goal 3: Critical Thinking/Reasoning/Problem Solving

Goal 4: School to Work Transition

Goal 5: STEM (Responses to "STEM Only" questions below is REQUIRED)

Goal 6: School and District Improvement Efforts

Goal 7: Building a Collaborative Learning Community

Goal 8: TPEP (Responses to "TPEP criterion" identification below is REQUIRED)

TPEP: This workshop will meet the clock hour requirement and is aligned to the following criterion:

CRITERION 1: Centering instruction on high expectations for student achievement.

CRITERION 2: Demonstrating effective teaching practices.

CRITERION 3: Recognizing individual student learning needs and developing strategies to address those needs.

CRITERION 4: Providing clear and intentional focus on subject matter, content and curriculum.

CRITERION 5: Fostering and managing a safe, positive learning environment.

CRITERION 6: Using multiple student data elements to modify instruction and improve student learning.

CRITERION 7: Communicating and collaborating with parents and the school community.

CRITERION 8: Exhibiting collaborative and collegial practices focused on improving instructional practice and student learning.

STEM Only: Select two (or more) STEM components this learning or activity includes as a specific focus.

Science

Technology

Math

Engineering

STEM Only: Describe how this PD will have an impact on STEM experiences for students?

STEM Only: Describe how this PD will provide examples or resources to use with students or with other educators?

STEM Only: Describe how this PD will provide examples or resources about STEM-related career choices to use with students?

Is your program/course a one-day only event, or does it recur and/or span more than one date/time slot? *

It is a one-day only event.

It recurs and/or spans more than one date/time slot.

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