Milford School District
Name:
Title of Activity:
Activity Date:
Year of Certification Expiration / Specify Endorsement Area
(only when requesting
CEUs in Content) / Content
Minimum 30 CEUs per endorsement per cycle / Knowledge of Learners and Learning
Minimum 45 CEUs total per cycle
Technology *
(15 CEUs min) / Personalization/ Differentiation
(10 CEUs min) / Learning
Community
(10 CEUs min) / Building / District
* Checklist CEU or Advanced Option
State the activity.
Identify and state to which goal(s) this activity relates.
☐ Individual
☐ Building
☐ District
Complete a summary reflection of the professional learning activity.
· Use the reflection questions on the back to develop your summary.
· Note - a reflection needs only to be done for activities that relate to Individual/Content goals.
Attach documentation of completed professional learning and submit to PD Building Rep. with updated CEU Summary Sheet. PD Rep will return both to you to keep with your records for annual review with Administrator/designee. NO COPIES WILL BE KEPT.
Approved by: / Date:
P.D. Representative Signature
Strategies # and Name
· On the Professional Development Activity form indicate the strategy # and name
· Refer to the Professional Development plan for a description of each strategy.
· The plan also outlines what documentation and evidence is needed for each strategy.
Traditional Professional Development Strategies
#1 Out-of-District workshops, webinars, institutes, and conferences
#2 In-District academies, early release, workshop days
#3 College courses
#4 District-approved committee participation
Job-Embedded Professional Development Strategies
#5 Book talk
#6 Action research
#7 Examining student work and student thinking
#8 Study groups/lesson study
#9 Peer observations
#10 Mentoring/coaching
#11 Curriculum development, implementation, and adaptation
#12 Professional networks
#13 Independent study
#14 Use of technology
#15 Professional developer/academy presenter
#16 Partnerships
State the Activity
· Simply indicate what the session was and possibly the presenter. A descriptive summary is not necessary.
Goal
· Check off to which goal(s) this activity fits.
· Write down the actual goal.
o Individual goals are on your Annual Goal-Setting/Review Form.
o Building and District Goals are listed on the PD website.
o Tip – Keep a copy of your Individual, Building, and District goals in your PD binder; update them yearly.
Summary Reflection
· The reflective piece is an effective way to move new learning to action. Importantly, it serves to examine how the activity increases your teacher effectiveness and/or student learning.
· Use the following questions to guide your reflection.
o What new information did you learn from this activity?
o How will the learning impact your classroom teaching?
o How will this learning impact your students’ achievement?
o Are there any follow-up sessions that could be offered from this session? Please list.
2015