Clock Hour Course Application Form
Used to apply to offer clock hours within the Raymond School District
Sponsoring Agency Information
Name of organization wishing to sponsor clock hours
(If Raymond School District, state this)
Your answer
Address 1
Your answer
Address 2
Your answer
City, State and Zip Code
Your answer
Individual Applicant Information
Information concerning the person completing the form
Name
Your answer
Email
Your answer
Phone number
Your answer
Proposed Class Information
Title of Class
Your answer
Location of Class
Your answer
Number of clock hours to be offered
Your answer
Session 1—Date; Start Time; End Time
Example: 10/2/14; 3:15 p.m.; 6:15 p.m.
Your answer
Session 2—Date; Start Time; End Time
Example: 10/2/14; 3:15 p.m.; 6:15 p.m.
Your answer
Session 3—Date; Start Time; End Time
Example: 10/2/14; 3:15 p.m.; 6:15 p.m.
Your answer
Session 4—Date; Start Time; End Time
Example: 10/2/14; 3:15 p.m.; 6:15 p.m.
Your answer
Session 5—Date; Start Time; End Time
Example: 10/2/14; 3:15 p.m.; 6:15 p.m.
Your answer
List objectives for this class
Your answer
Agenda for the class
Include order and amount of time for each agenda item.
Your answer
How does this class relate to our School Improvement Goals?
Your answer
Do participants have the option of using this class for college credit?
Evaluation
If using your own evaluation form, please email it to sholland@raymondk12.org. The following elements are required:
i. Extent to which written objectives have been met
ii. Quality of the physical facilities
iii. Quality of oral presentation by each instructor
iv. Quality of the written materials provided by each instructor
Evaluation form will be:
If using your own form, email it to sholland@raymondk12.org.
Vita
State law requires that clock hour classes be provided by someone who is qualified in that area. Please send your vita to sholland@raymondk12.org.
Submit
Never submit passwords through Google Forms.
This form was created inside of Raymond School District. Report Abuse - Terms of Service - Additional Terms