Tussey Mountain School District

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zumu_ezf_spec

name01=PPID # type01=text details01=text:PPID ~size: name02=(a) Name (First and Last) type02=text details02=text:~size:45 name03=(b) Workshop Date AND Title: type03=radio

details03=text:correct:list:12/12/11 - Common Core Standards (3 hrs.)

1/16/12 - Standards Aligned Systems (SAS) (4 hrs.)

Other

name04=(c) If "OTHER", describe (Include Date(s) and Wrkshp Title) type04=textarea details04=text:~size:45 name05=(d) Sign In Time: type05=text

details05=text:correct:list:SELECT ONE (Required)

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)

9/3/10-Technology Integration into Classroom (HS)

Other

name06=(e) Sign Out Time: type06=text details06=text:cols:45rows:3 name07=(f) Total Attended Hours: type07=text details07=text:~size:5 name08=(g) Name of Instructor-Presenter type08=text details08=text:~size:45 name09=Questions 1 - 8 (5=Excellent to 1=Poor) type09=radio details09=text:correct:list: name10=Q1: Activity was well organized. (5 4 3 2 1) type10=text details10=text:~size:5 name11=Q2: Activity objectives were clearly stated. (5 4 3 2 1) type11=text details11=text:~size:5 name12=Q3: Activity/assignments were relevant to objectives. (5 4 3 2 1) type12=text details12=text:~size:5 name13=Q4: The instructor was well prepared. (5 4 3 2 1) type13=text details13=text:~size:5 name14=Q5: The instructor was knowledgeable in the subject area. (5 4 3 2 1) type14=text details14=text:~size:5 name15=Q6: The manner of presentation of the material was clear. (5 4 3 2 1) type15=text details15=text:~size:5 name16=Q7: The instructor employed effective teaching strategies-techniques. (5 4 3 2 1) type16=text details16=text:~size:5 name17=Q8: The instructor was objective and equitably interacted with the class. (5 4 3 2 1) type17=text details17=text:~size:5 name18=(h) Additional Comments: type18=textarea details18=text:cols:45rows:3 name19=(i) Print/Certify/Submit type19=radio

details19=text:correct: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.list: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.

name20= type20= details20= name21= type21= details21=text:cols:20rows:1 name22= type22=

details22=text:~list:This is to certify that you have satisfactorily completed the activity as noted above. In recognition of your effort, you have been awarded ____ CPE hours. These hours have been reported to the PDE Act 48 CPE Record System. It is important that you retain a copy of this form in your files. ________________________________________ Authorized Signature

name23= type23= details23= name24= type24= details24= name25= type25= details25= name26= type26= details26= name27= type27= details27= name28= type28= details28= name29= type29= details29= name30= type30= details30= name31= type31= details31= name32= type32= details32= name33= type33= details33= name34= type34= details34= name35= type35= details35= name36= type36= details36= name37= type37= details37= name38= type38= details38= name39= type39= details39= name40= type40= details40=

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MISSION STATEMENT

The continuing mission of the Tussey Mountain School District

is to provide a safe, stimulating, and challenging environment where every person has an

equal opportunity to attain the knowledge and skills necessary to become

lifelong learners who contribute positively to society."

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