UNION COUNTY SCHOOLS

[Pages:1]UNION COUNTY SCHOOLS

APPROVAL FORM FOR CLASSROOM VISITATION, LEARNING COMMUNITIES, ACTION RESEARCH

NAME: _______________________________ SOCIAL SECURITY NUMBER: __________________ SCHOOL: _____________________________ DATE: __________________ TOPIC OF STUDY: ___________________________________________________________________

Check which area the activity is intended to address In-service must address achievement of students for whom you are responsible through one of the four areas below

Recertification: Indicate addressed certification area(s): ____________________________________ School/Dept. Improvement Plan: Indicate addressed goal area: _______________________________ Individual Professional Development Plan: Indicated addressed objective: ______________________ Educator Accomplished Practices (circle addressed practice: assessment, communication, continuous improvement, critical thinking, ethics, diversity, human development and learning, knowledge of subject matter, learning environments, teacher role, technology)

Classroom Visitation Learning Communities Action Research

TYPE OF ACTIVITY (CHECK ONE)

1. Prior Approval Form 2. Self-Study Form 3. Time/Activity Log

1. Prior Approval Form 2. Self-Study Form 3. Time/Activity Log

1. Prior Approval Form 2. Self-Study Form 3. Time/Activity Log

Approved by: _________________________

Principal's Signature

Approved by: _________________________

Principal's Signature

Approved by: _________________________

Principal's Signature

Describe the activity and the knowledge or skill(s) you hope to obtain that will benefit the students for whom you are responsible:

____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

Number of in-service points requested ______ points Beginning Date: _______________ Ending Date: _________________

I approve the in-service credit request for the above described professional development activity Approval denied for the following reason: ______________________________________________ Signature of Principal: _______________________ Date: __________________ Signature and Approval by District Administrator: _________________________ Date: ______________

UCSB 0388 (JUNE 2004)

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