Professional Development Clock Hour Approval Form – Illinois Education Association

Number of days of training*

Training Date (Day 1)*

Start Time (Day 1)*

:

End Time (Day 1)*

:

Breaks and Meals - Day 1 (minutes)*

PD Clock Hours may only be offered for actually learning time. Meals and breaks mustl be subtracted from the total number of hours. Please select the total number of minutes for breaks and meals.

Total Hours Requested - Day 1*

Training Date (Day 2)*

Start Time (Day 2)*

:

End Time (Day 2)*

:

Breaks and Meals - Day 2 (minutes)*

PD Clock Hours may only be offered for actually learning time. Meals and breaks must be subtracted from the total number of hours. Please select the total number of minutes for breaks and meals.

Total Hours Requested - Day 2*

Training Date (Day 3)*

Start Time (Day 3)*

:

End Time (Day 3)*

:

Breaks and Meals - Day 3 (minutes)*

PD Clock Hours may only be offered for actually learning time. Meals and breaks must be subtracted from the total number of hours. Please select the total number of minutes for breaks and meals.

Total Hours Requested - Day 3*

Training Date (Day 4)*

Start Time (Day 4)*

:

End Time (Day 4)*

:

Breaks and Meals - Day 4 (minutes)*

PD Clock Hours may only be offered for actually learning time. Meals and breaks must be subtracted from the total number of hours. Please select the total number of minutes for breaks and meals.

Total Hours Requested - Day 4*

Summer Leadership Academy

Summer Leadership Academy

Request for PD Hours (PDHs)

Step 1 of 6

Requestor Details

Professional Development Details