In-District PL for Educators e-Request
Use this form to request in-district Professional Learning for educators.
First Name (of person completing this form) *
Your answer
Last Name (of person completing this form) *
Your answer
Email of person completing this form: *
Your answer
Who else would you like to receive a confirmation or copy of this request? (i.e., teacher leader, department chair, superintendent, etc.)? Please include all emails separated by a comma. *
Your answer
Priority: *
School District: Select all districts that apply. *
Required
Target Audience: Intended PL participants. *
Regional Priorities
Grade Levels: Choose the one that is most appropriate *
Content Area(s): *
If you chose integrated or all, please specify the content below:
Your answer
Narrative
What are the intended learning outcomes for educators? What are the learning outcomes for students?
Learning Outcomes for Educators *
Your answer
Learning Outcomes for Students *
Your answer
Scheduling
Specify preferred dates and times for up to three sessions. Please allow a minimum lead time of two weeks from date of request to date of first session.
Session Date 1 *
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Session 1 start time *
Time
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Session 1 end time *
Time
:
Session Date 2
MM
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DD
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YYYY
Session 2 start time
Time
:
Session 2 end time
Time
:
Session Date 3
MM
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DD
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YYYY
Session 3 start time
Time
:
Session 3 end time
Time
:
Additional Information:
Please provide additional explanatory information and include web links, images and attachments.
Addtional Information Narrative
Your answer
Submit
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