Tennessee
|[pic] |Tennessee Department of Children’s Services |
| |Professional Development Waiver |
|Employee Name: |Employee ID: | |Job Title: |
|Region/YDC/Central Office: |Supervisor: |
|Person Making Request: |Title: |Date of Request: |
|Waiver Type |
| General (FMLA, Military Leave) *See form Instructions for | Profession (attorney, psychologist…) | Graduate Assistant |
|definition | | |
| Other (Explain) |
|Details of request (list reasons for request, employee qualifications that make them exempt and any other pertinent information): |
|Substitution Course Data |
|*If requesting to substitute a course, provide information below. |
|Course Title: |Substitution Course Title: |
|Professional Development Source for Substitution Course: |
|(i.e., CBT, Internal Offering, External Agency, etc.) |
|Date completed: |Number of Hours: |
|Course Description: |
|Certificate of Completion Attached: Yes No |
|(A copy of this certificate must accompany this request) |
|Approvals |
| Approved Denied |Reason for Denial: |
|Supervisor Print: |Supervisor Signature: |
| | |
|RA/RID/Superintendent Print: |RA/RID/Superintendent Signature: |Date: |
|DO NOT WRITE BELOW THIS LINE --- FOR THE TRAINING DIVISION ONLY |
| Approved Denied |Reason for Denial: |
|Training Designee Print: |Training Designee Signature: |
| | |
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