Certificate Renewal Request



South Carolina School Districts

Certificate Renewal Credit Appeal Form

for Professional Educator’s Certificate

Richland School District One

|Last Name |First Name |Middle/Maiden |

|Social Security Number |SC Certificate Number |Area(s) of Certification |

|Employer (include office or school)-Richland One |Position |

|School/Office: | |

Please attach a copy of the signed Renewal Credit Pre-Approval and Verification Form you are appealing.

The Professional Development Standards are used to determine if Professional Development/Certificate Renewal Activities meet state requirements for High Quality Professional Development.

On the following page, please answer the questions in the right column for each Professional Development Standard as it relates to the Professional Development Activity you are appealing.

For further explanation of the Professional Development Standards, please visit



PROFESSIONAL DEVELOPMENT STANDARD

|Context |Learning Communities |How does the PD Activity promote Learning Communities |

| |Staff development that improves the learning of all students organizes adults into |in the school and/or district? |

| |learning communities whose goals are aligned with those of the school and district. | |

| |Leadership |How does the PD Activity promote Leadership in the |

| |Staff development that improves the learning of all students requires skillful school|school and/or district? |

| |and district leaders who guide continuous instructional improvement. | |

| |Resources |How does the PD Activity promote the effective use of |

| |Staff development that improves the learning of all students requires resources |Resources in the school and/or district? |

| |(effective use of time and people) to support adult learning and collaboration. | |

|Process |Data Driven |What data was used to determine the need for this PD |

| |Staff development that improves the learning of all students uses disaggregated |Activity? |

| |student data to determine adult learning priorities, monitor progress, and help | |

| |sustain continuous improvement. | |

| |Evaluation |How will the PD Activity be evaluated in terms of |

| |Staff development that improves the learning of all students uses multiple sources of|participants’ reaction; |

| |information to guide improvement and demonstrate its impact. |teachers’ acquisition of new knowledge and skills; |

| | |how that learning affects teaching; |

| | |how those changes in practice affect student learning; |

| | |how staff development has affected school culture and |

| | |other organizational structures? |

| |Research-Based |What published research documents the proven |

| |Staff development that improves the learning of all students prepares educators to |effectiveness of the PD Activity in improving student |

| |apply research to decision making. |achievement? (annotated bibliography entry) |

| |Design |What Learning Designs (delivery methods, such as |

| |Staff development that improves the learning of all students uses learning strategies|collaborative lesson design, action research, study |

| |appropriate to the intended goal. |groups, professional networks, coaching, online) are |

| | |being used in the PD Activity? |

| |Learning |How does the PD Activity model the learning methods |

| |Staff development that improves the learning of all students applies knowledge about |that teachers are expected to use with their students? |

| |human learning and change. | |

| |Collaboration |How does the PD Activity promote Collaboration? |

| |Staff development that improves the learning of all students provides educators with | |

| |the knowledge and skills to collaborate. | |

|Content |Equity |How does the PD Activity support all students achieving|

| |Staff development that improves the learning of all students prepares educators to |at high levels? |

| |understand and appreciate all students, create safe, orderly, and supportive learning| |

| |environments, and hold high expectations for their academic achievement. | |

| |Quality Teaching |How does the PD Activity promote Quality Teaching? |

| |Staff development that improves the learning of all students deepens educators' | |

| |content knowledge, provides them with research-based instructional strategies to | |

| |assist students in meeting rigorous academic standards, and prepares them to use | |

| |various types of classroom assessments appropriately. | |

| |Family Involvement |How does the PD Activity directly or indirectly promote|

| |Staff development that improves the learning of all students provides educators with |or support Family Involvement? |

| |knowledge and skills to involve families and other stakeholders appropriately. | |

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For HRS Use Only

Date Received: _____________

Pre-Approval Authorized: _____

HRS Signature: _____________

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