Form must be turned in to Teaching & Learning Coordinator at least 3 weeks prior to event.

Title of Class:

Event Description:

Number of Clock Hours (minimum of 3):

Presenters (Enter all presenters. For new presenters please fill out a Vitae or resume and sent to Sequim Teaching &Learning separately. If you have more presenters than space allows, contact T&L):

Date(s) of Class(es):

Time(s) of Class(es):

Location of Class(es):

Activities must relate to opportunities for participants to: collect and analyze evidence related to student learning; professional certificate standards; school and district improvement efforts; K-12 frameworks and curriculum alignment; research-based instructional strategies and assessment practices; content of current or anticipated assignment; advocacy for students and leadership, supervision, mentoring/coaching; and/or building a collaborative learning community. Objectives (Enter 3 or more objectives based on the activities below. Identify what your participants will learn and how it may be applied):

STEM Offering? Yes No

If yes, complete STEM information below.

STEM Hours:

STEM Offering must include content from 2 of the 4 STEM elements

Science

Technology

Engineering

Mathematics

Will the STEM activity have an impact on STEM experiences for students?

Yes No

Does the STEM activity provide examples or resources to use with students or with other educators?

Yes No

Does the STEM activity provide examples or resources about STEM-related career choices to use with students?

Yes No

TPEP Offering? Yes No

If yes, complete TPEP information below.

TPEP Hours:

To qualify for a TPEP training, course must contain at least one criterion from the following list and evidence for each criteria may be documented either by copying information from the course description, objectives or agenda; or you may add additional information that provides rationale for the criteria.

Teacher Evaluation Criteria

Criterion 1	Criterion 5

Criterion 2	Criterion 6

Criterion 3	Criterion 7

Criterion 4	Criterion 8

Enter the rationale for each selected Teacher Criteria:

Agenda for the clock hour proposal must be sent electronically to Teaching & Learning Coordinator. If the presenter(s) is new to the Sequim School District (or has never presented before) please send an electronic copy of a current resume or OESD Vitae Form (request from T&L) for each presenter.