Educator/Presenter Request to Receive Professional Development Hours (PDH) for Presentation Preparation
This form is meant to be completed and submitted to your ISBE Approved Professional Development Provider prior to or on the day of your presentation.  Please keep in mind when completing the following form that presenters receive credit for the preparation for the presentation and not the presentation itself.  Please note that in addition to completing this form your PD provider, please keep a digital scan/copy of the following items as you may be asked to submit them at a later date:
           * Conference program or printed workshop summary with your name listed as a presenter
           * Any materials you shared with your participants such as a power point, videos, books, handouts, or agenda.

Professional Development Hours (PDH) can be given only once for the preparation of a session.  If  you have received PDs for this session previously, then none can be given a second time.
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What is your email address? *
What is your first and last name? *
What is the name of the institution where you hold your current teaching position? *
What is your IEIN Number? *
This is required from ISBE and can be found on your ELIS account.
Name of your presentation *
Date of your presentation *
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Name of the event where you presented *
Please include the facility and name.
Length of your presentation *
Please respond in hours.  Do not include breaks or lunch.
How did your preparation for the event advance your growth as an educator and/or the growth of your students? *
Reflecting the Outcomes Learning Forward Standards (mark N/A if not applicable to your preparation)
Provide a list of resources (substantive, reputable materials ex. books. peer review journals, research, evidence-based findings) used to create the presentation. *
Please denote which national World-Readiness standards for Learning Languages have been included in your preparation and consequently, your presentation? *
What will participants be able to do after leaving your session? *
To answer the next questions refer to these Learning Forward Standards  Please complete each question as it allows your PD provider and ISBE to better understand the depth of your preparation.
Learning Communities: Professional learning that increases educator effectiveness and results for all students occurs within learning communities committed to continuous improvement, collective responsibility, and goal alignment.

Resources: Professional learning that increases educator effectiveness and results for all students requires prioritizing, monitoring, and coordinating resources for educator learning.

Learning Designs: Professional learning that increases educator effectiveness and results for all students integrates theories, research, and models of human learning to achieve its intended outcomes.

Outcomes: Professional learning that increases educator effectiveness and results for all students aligns its outcomes with educator performance and student curriculum standards.

Leadership: Professional learning that increases educator effectiveness and results for all students requires skillful leaders who develop capacity, advocate, and create support systems for professional learning.

Data: Professional learning that increases educator effectiveness and results for all students uses a variety of sources and types of student, educator, and system data to plan, assess, and evaluate professional learning.

Implementation:  Professional learning that increases educator effectiveness and results for all student applies research on change and sustains support for implementation of professional learning for long term change.
Please provide a description of how your presentation preparation better connected you to your colleagues, profession as described in the standard.   *
Reflecting the Leadership Learning Forward Standard
How did your preparation build capacity or create a system of support within your topic area or within the education profession? *
Reflecting  the Leadership Learning Forward Standard.  (Mark N/A if not applicable to your presentation.)
How would you evaluate your presentation on effectiveness? How do you plan to follow up with participants about your session? *
Reflecting the Data Learning Forward Standard.  (Mark N/A if not applicable to your presentation.)
What long term effect did/will your preparation have on your curriculum and what implication did/will your session content have for your participants?   *
Reflecting the Implementation Learning Forward Standard.  (Mark N/A if not applicable to your presentation.)
Time spent on preparation
Taking into consideration the Learning Forward Standard goals and the quality time you spent preparing for the presentation, please record the active time you spent not giving the presentation, but the time you spent preparing.
How many hours did you spend preparing for your presentation? *
Please reflect ONLY on  the preparation  time and NOT the presentation time.
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