Sponsoring Prov Contact
Sponsoring Prov phone
Name of Instructors
Requesting approval for vocational clock hours:
Detailed qualifications of instructor attached.
On file in the Vocational Certification Office.
TITLE
First Date of Inservice
Time(s)
Total number of continuing clock hours:&RPSOHWHRXWOLQHRUDJHQGDDWWDFKHG<HV1R
If yes, name of college or university:
Yes No
INSERVICE OUTCOMES AND/OR OBJECTIVES. Please provide a description of a minimum of two and a maximum of
four outcomes/objectives of the inservice. Note: One objective must describe how the inservice will address
nontraditional training and employment opportunities associated with these outcomes/objectives. Do not use
attachments for outcomes/objectives and/or instructor name(s).
Career and Technical Education
APPROVAL TO PROVIDE INSERVICE EDUCATION
Sponsoring Provider Name
Address
Office of Superintendent of Public Instruction
Career and Technical Education (CTE)
Old Capitol Building
PO BOX 47200
Olympia, WA 98504-7200
Yes No
INSERVICE INFORMATION (conference, course, training, etc.) 1DPHRI,QVHUYLFH3URYLGHU
Will participants have the option of using the offering for college or university credit?
•
•
•
•
Total Attendance:
Location
Last Date of Inservice
Approval Date:
All information must be completed on this form
and submitted to OSPI 30 days in advance of inservice for approval.
Please do not handwrite. An agency approved by the State Board of Education to serve as a provider for inservice education
programs will formulate a committee or board of directors to grant prior approval for proposed inservice education programs.
Address:
Request made by: Phone Fax
Email
(Must provide resume or certification number
)
(Must provide OSPI program contact )
Using provider approved format
Special format attached which includes:
EVALUATION FORM
extent to which written outcomes/objectives have been met,
quality of the physical facilities,
quality of the oral presentation by each instructor,
quality of the written materials provided by each instructor.
VCES 103 Layout #3 (
)
Note: One objective must describe how the inservice will address nontraditional training and employment opportunities
associated with these outcomes/objectives.
Notes:
Date Requested:
Presenter(s) Certification Number
**FOR ADMINISTRATIVE USE ONLY**
