Appendix A Revised: 7/1/17

Jefferson County Educational Service Center Certificate of Professional Development Credit

Name: 	             District: 	

Professional Development Activity: 	

Instructor / Facilitator: 	

Activity Date(s) or Timeline: 	

Clock Hours: 	                                     Equivalent CEU’s: 	

Program Overview

Program Objectives and Intended Audience

Opportunities for Participant Follow-Up

Please Keep this Certificate.	(Verification of Satisfactory Completion)

Signature Project Director: 	      Date: 	

* (Embossed Seal)

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