Request Clock Hours for Event

Please complete this form to request that WAFLT sponsor clock hours for your event.
Basic procedures:

WAFLT will offer clock hours if a WAFLT board member or designated WAFLT representative is present at the event. If a designated representative is not present, than approval for clock hours must be requested to Clock Hour Chair Caitlin Tumlinson.

1. WAFLT must be a sponsor or co-sponsor of the event and a WAFLT board member or WAFLT designated representative must be present. If this has not been set up yet, please visit our website and click on the tab for Clock Hours under Resources.

2. Once WAFLT is offering clock hours for an event, they must be considered as co-sponsoring the event. Our logo and information must be present on any type of communication such as flyers or website posts. You much include our logo, name and website link. If applicable, include our Facebook link too. If you have any questions or concerns, please contact Clock Hour Chair Caitlin Tumlinson at

3.Once at the event, make sure all the paperwork is complete and accurate:

a. Sign in sheet that includes title of the event, date and location. Attendees must include their full name, email and signature.

b.Upon completion of the event, have attendee’s first fill out the evaluation form. WAFLT must receive an evaluation form per clock hour form submitted. It is best to have the attendee turn in the evaluation form and then be given the clock hour form.

c. Have attendees fill out the clock hour form and instruct them to turn the form into their school district and to always make a copy for their record. WAFLT will not have a copy of the clock hour form.

4. Turn in the sign in sheets and evaluations to Clock Hour Chair Caitlin Tumlinson at
Email address *
Name of Requester *
Your answer
Requesting Organization *
Your answer
Name of Presenter *
Your answer
Phone number of Requester *
Your answer
Location of the event *
Your answer
Date of event *
Time of event *
Amount of clock hours to be provided (minimum of 1) *
Your answer
Do these clock hours meet the STEM certificate renewal requirement (An authentic integration of two or more STEM components: Science, Tech, Engineering, Math) *
Title of the event *
Your answer
Target audience *
Your answer
Target language(s) *
Your answer
Agenda *
Your answer
Event Description *
Your answer
How will this learning impact participants' professional educational practice?
Your answer
How will this professional learning impact students?
Your answer
Any additional notes or information?
Your answer
A copy of your responses will be emailed to the address you provided.
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