Appendix D (ADM)

Rev. 4/18/07

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 (ü) the area of professional development related to this EOA.

( ) Competency 1 ~ Facilitating the Vision

( ) Competency 2 ~ School Culture and Instructional Program

( ) Competency 3 ~ Managing the Organization

( ) Competency 4 ~ Collaboration and Community Engagement

( ) Competency 5 ~ Ethics and Integrity

( ) Competency 6 ~ Understanding the Publics

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, and complete participant reflection on the back.

Verification Signature Position Date