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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: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
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=


Tussey Mountain School District
199 Front Street - Saxton, PA 16678-8610
(814) 635-3670 - District Office              (814) 635-2975 - High School Office
E-Mail: tmsd-webmaster@comcast.net




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