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Arch Ford Service History Report 24-25
Use this form to document support provided to schools, coops, or state entities. This form will capture school visits, digital support, and PD offerings.
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* Indicates required question
AFESC Employee (First name/last name)
*
Your answer
Additional AFESC Employee(s) in Attendance
Your answer
Date
*
MM
/
DD
/
YYYY
Brief Description of Purpose of Visit
Your answer
Number of Participants
*
Your answer
District Contact Person
Your answer
Service Time (Hours/Minutes ex. 2.5 for 2 and a half hours; 1.75 for an hour and 45 minutes; 3.25 for three hours 15 min; etc.)
*
Your answer
District/School
*
Academics Plus Charter
Arkansas School for the Blind
Atkins
Clinton
Conway
Danville
Dardanelle
Dover
East End
Greenbrier
Guy-Perkins
Heber Springs
Hector
Mayflower
Mt. Vernon-Enola
Nemo Vista
North Little Rock
Perryville
Pottsville
Quitman
Russellville
Shirley
South Conway County
South Side
Two Rivers
Vilonia
West Side
Western Yell County
Wonderview
College or University
DESE
Work Outside of Region
All Arch Ford Districts
DCTE
Other:
Type of Support
*
Professional Development
Coaching
Modeling
Observation/Feedback of Teaching
Attending Team Meeting
Technical Support (Compliance Support, Scheduling Visits, Grant-writing)
Leadership
Data Work
Book Study
Facilities Support
Financial Technical Support
Novice Teacher Support
Technology Integration Support
Technology Infrastructure Support
Professional Learning Communities (PLC)
DESE Initiatives
Other:
Required
Type of Contact
*
On-Site
Zoom or Other Digital Meeting
Extensive Phone Call or Text Support
Extensive Email Support
Personalized PD Held at Another Site
Other:
Required
Mileage Calculator Information
This section is optional. Only use if you plan to copy this information into your monthly mileage calculator. The instructions linked below will provide instructions on how to copy information from this form into your monthly mileage report:
http://bit.ly/AFTravelInstructions
Travel Origin City
Your answer
Travel Destination City
Your answer
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