Tussey Mountain School District

Act 48 Data Form

~ALL FIELDS (*) MUST BE COMPLETED~

PPID
*(a) Name (First and Last)
*(b) Workshop Date AND Title:	8/3/10 and 8/4/10-Technology Training for Teachers 8/12/10-Writing Effective IEPs 9/2/10-Progress Book Lesson Plan (Elem)(1 hr) 9/3/10-Technology Integration into Classroom (HS)(1.5 hr) Other
(c) If "OTHER", describe (Include Date(s) and Wrkshp Title)
*(d) Sign In Time:
*(e) Sign Out Time:
*(f) Total Attended Hours:
(g) Name of Instructor-Presenter
Questions 1 - 8 (5=Excellent to 1=Poor)
*Q1: Activity was well organized. (5 4 3 2 1)
*Q2: Activity objectives were clearly stated. (5 4 3 2 1)
*Q3: Activity/assignments were relevant to objectives. (5 4 3 2 1)
*Q4: The instructor was well prepared. (5 4 3 2 1)
*Q5: The instructor was knowledgeable in the subject area. (5 4 3 2 1)
*Q6: The manner of presentation of the material was clear. (5 4 3 2 1)
*Q7: The instructor employed effective teaching strategies-techniques. (5 4 3 2 1)
*Q8: The instructor was objective and equitably interacted with the class. (5 4 3 2 1)
(h) Additional Comments:
*(i) Print/Certify/Submit	I certify this information to be true and complete. I understand that any misleading or incorrect data will render this Act 48 Data Form void.
* fields are required