Jefferson County Educational Service Center Consortium

Local Professional Development Committee

Individual Professional Development Plan

Basic Information

Please complete the following (Typing preferred):

Name Date

District Building

Home Address

Phone Numbers – Home: School:

E-Mail

Current Teaching/Administrative Assignment

Grade(s) Subject Area(s) Building Level #of Years

Previous Teaching/Administrative Assignment (Most Recent Only)

Grade(s) Subject Area(s) Building Level #of Years

Total # of Years Teaching/Administrative Experience

License 1 License 2 License 3

v Current License Identification Number

v Subject Areas Listed on This License

v Effective Date New License Begins

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Certificate 1 Certificate 2 Certificate 3

u Current Certificate Identification Number

u Subject Areas Listed on This Certificate

u Effective Date New License Begins

Please Note: This completed and signed 6-page IPDP (Form #1 & Form #2) must be submitted to your district superintendent’s office at the same time you submit your renewal packet.