Appendix D (ADM) Revised: 7/1/17

JEFFERSON COUNTY EDUCATIONAL SERVICE CENTER CONSORTIUM LOCAL PROFESSIONAL DEVELOPMENT PLAN

EQUIVALENT OTHER ACTIVITY (EOA) DOCUMENTATION VOUCHER Administrators

Name_________________________________________________________________________

CEU Option __________________________ Number of CEUs __________________________

Please check () the area of professional development related to this EOA.

Standard 1: Standard 2: Standard 3: Standard 4: Standard 5: Standard 6:
Standard 7:

Learning Communities Leadership
Resources Data
Learning Designs Implementation
Outcomes

From your IPDP, copy the applicable goal. ___________________________________________ ______________________________________________________________________________

Write a brief description of the EOA and how it helped you to grow professionally; include date(s) when activity or portions of the activity was/were performed.

The signature(s) below verify that this report describes the EOA performed in partial fulfillment of my Individual Professional Development Plan (IPDP).

Signature of Participant	Date

Attach any publications, copies of certificates, agendas, etc. that could be used for verification or include a signature of verification.

Verification Signature	Position	Date

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