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SLSD 2019-2020 Academy Request
Thank you for your interest in participating in a self-designed Professional Development Academy for the 2019-2020 school year. This form is to be completed if you are proposing to participate in a CLIU workshop, independent study, focus group with a pre-determined team, online academy, or professional project. THIS FORM DOES NOT NEED TO BE COMPLETED IF YOU ARE TAKING AN ACADEMY WORKSHOP OFFERED BY SLSD.
I am
Event Name *
What is the title of your academy request
Your answer
Event Type *
Target Audience *
Please include your name and the names of all other participants (if applicable).
Your answer
Description *
Your answer
Location *
Your answer
Instructor(s) Name *
Your answer
Start Date *
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DD
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YYYY
End Date *
MM
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DD
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YYYY
Start Time *
For a multiple day academy (focus group, independent study, online academy) use 12:00 AM
Time
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End Time *
For a multiple day academy (focus group, independent study, online academy) use 12:00 PM
Time
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Academy Hours Requested *
Your answer
Act 48 Hours Requested *
Your answer
Principal's Name *
To which Professional Development Focus Area(s) do you believe this workshop would be associated? *
Check all that apply
Required
I would classify this proposal as: *
Academy Responsibilities *
I understand that by participating in this independent study/focus group/online academy, I will be responsible for providing proof of attendance/completion of activities to my supervisor. For CLIU Workshops, once attendance has been confirmed by the presenter, FLEX hours will be added to the event.
Required
Name of Person(s) Submitting Request *
Your answer
Email address
This will be used to send you a copy of your responses
Your answer
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