"Professional Development Documentation Form - Mountain Home School District"

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MOUNTAIN HOME SCHOOL DISTRICT
PROFESSIONAL DEVELOPMENT DOCUMENTATION FORM
School Year________________
Name: ______________________________
Building:____________________
Position:___________________
*College Courses
1. Name of Course:_____________________________________________
Course Number:___________________________
Institution:__________________________________________________
Semester: ____________Prof. Dev. Hours:_____
2. Name of Course:_____________________________________________
Course Number:___________________________
Institution:__________________________________________________
Semester: ____________Prof. Dev. Hours:_____
*Conferences. Workshops. Seminars, Institutes
1. Title:______________________________________________________
Agency:__________________________________
Presenter:__________________________________________________
Date:____________ Prof Dev. Hours:_____
2. Title:______________________________________________________
Agency:__________________________________
Presenter:__________________________________________________
Date:____________ Prof Dev. Hours:_____
3. Title:______________________________________________________
Agency:__________________________________
Presenter:__________________________________________________
Date:____________ Prof Dev. Hours:_____
4. Title:______________________________________________________
Agency:__________________________________
Presenter:__________________________________________________
Date:____________ Prof Dev. Hours:_____
5. Title:______________________________________________________
Agency:__________________________________
Presenter:__________________________________________________
Date:____________ Prof Dev. Hours:_____
6. Title:______________________________________________________
Agency:__________________________________
Presenter:__________________________________________________
Date:____________ Prof Dev. Hours:_____
MOUNTAIN HOME SCHOOL DISTRICT
PROFESSIONAL DEVELOPMENT DOCUMENTATION FORM
School Year________________
Name: ______________________________
Building:____________________
Position:___________________
*College Courses
1. Name of Course:_____________________________________________
Course Number:___________________________
Institution:__________________________________________________
Semester: ____________Prof. Dev. Hours:_____
2. Name of Course:_____________________________________________
Course Number:___________________________
Institution:__________________________________________________
Semester: ____________Prof. Dev. Hours:_____
*Conferences. Workshops. Seminars, Institutes
1. Title:______________________________________________________
Agency:__________________________________
Presenter:__________________________________________________
Date:____________ Prof Dev. Hours:_____
2. Title:______________________________________________________
Agency:__________________________________
Presenter:__________________________________________________
Date:____________ Prof Dev. Hours:_____
3. Title:______________________________________________________
Agency:__________________________________
Presenter:__________________________________________________
Date:____________ Prof Dev. Hours:_____
4. Title:______________________________________________________
Agency:__________________________________
Presenter:__________________________________________________
Date:____________ Prof Dev. Hours:_____
5. Title:______________________________________________________
Agency:__________________________________
Presenter:__________________________________________________
Date:____________ Prof Dev. Hours:_____
6. Title:______________________________________________________
Agency:__________________________________
Presenter:__________________________________________________
Date:____________ Prof Dev. Hours:_____
District sponsored/provided
1. Title:___________________________________________________
Location:_________________________________
Presenter:_______________________________________________
Date:_______________ Prof. Dev. Hours:______
2. Title:___________________________________________________
Location:_________________________________
Presenter:_______________________________________________
Date:_______________ Prof. Dev. Hours:______
3. Title:___________________________________________________
Location:_________________________________
Presenter:_______________________________________________
Date:_______________ Prof. Dev. Hours:______
4. Title:___________________________________________________
Location:_________________________________
Presenter:_______________________________________________
Date:_______________ Prof. Dev. Hours:______
5. Title:___________________________________________________
Location:_________________________________
Presenter:_______________________________________________
Date:_______________ Prof. Dev. Hours:______
6. Title:___________________________________________________
Location:_________________________________
Presenter:_______________________________________________
Date:_______________ Prof. Dev. Hours:______
*Other eligible activities
1. Description of Activity:______________________________________________________________________________________
Location:____________________________________________________Date:______________Prof. Dev. Hours:____________
2. Description of Activity:______________________________________________________________________________________
Location:____________________________________________________Date:______________Prof. Dev. Hours:____________
Approved by ____________________________________Principal
*Documentation must be provided for your personnel file and for verification for license renewal. Sixty (60) hours of
professional development must be obtained during this school year.
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