GFPS PIR Special Request Form
In order to earn Flexible PIR credit, this form must be filled out and approved PRIOR to attending a professional learning opportunity outside of the district's offerings.

AFTER FILLING OUT THIS FORM, ALSO REGISTER FOR A SPECIAL REQUEST ON PIR eCENTRAL.

Don't hesitate to contact Shelly Kelly (Elementary Coordinator) or Susan Quinn (HS Coordinator) if you have any questions.

Email address *
First Name *
Your answer
Last Name *
Your answer
School(s) *
Teaching Assignment *
PK-6, please list grade level and specialty area if applicable (psych, counselor, literacy, etc.); 7-12, please list grade level(s) and content area or specialty area.
Your answer
Event Title *
Your answer
Event Description *
Your answer
Event website that includes an agenda/schedule *
If you don't know where to find this online, and only have a hard copy of the event information, scan it and send it to Shelly Kelly (elementary) or Susan Quinn (secondary). If you choose that option, type in the field below how it will be received (emailing event information OR sending event information through school mail).
Your answer
Event City *
Your answer
Event State (or foreign country, if applicable) *
Your answer
Event Contact Person *
Your answer
Event Contact Person Email Address *
Your answer
Start Date *
MM
/
DD
/
YYYY
End Date *
MM
/
DD
/
YYYY
Meeting Times *
Example: 8-11 and 12-5 Fri; 8-12 Saturday
Your answer
Is this professional development activity outside of the duty day and/or contract year? *
Number of PIR hours requested *
Any additional information about this activity or comments can be left below (optional).
Your answer
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