State Continuing Education Clock Hours Program Application

Application type *

New—This is the first time this is being offered for SCECHs.

Update—This application is for an additional offering of a previously approved program.

Program approval number

Title (what will appear on the Approved Program webpage) *

Format *

Blended/Hybrid: Program is a combination of face-to-face and virtual/online

Face-to-Face: Participants physically attend entire program

Virtual/Online: Entire program through some type of virtual/online media

Your Company/Organization

Name of Company/Organization *

Address Line 1 *

Address Line 2 *

City *

State *

Zipcode *

Event Location

Same as Organization Address

Building *

Address Line 1 *

Address Line 2 *

City *

State *

Zipcode *

Category *

Narrative (include basic information to let participant know what the program is about) *

Prerequisites (any program they must take prior to this program; if none, state None) *

Attendance method/internal notes (describe the attendance method you are using for this program and you may include other information needed by sponsor/coordinator about this program) *

Technical specifications (only for online programs—specific computer needs for this program) *

Participant fee (required payment to participate in this program) * $

Is this a conference?

Yes

Minimum # of hours available (cannot be less than 3)

Total contact hours (maximum number of hours available) *

The actual time used for instruction. Do not count the welcome, breaks, lunch, dinner speeches, homework, preparation time, registration, or similar non-instructional activities.

Program descriptor *

Secondary program descriptor

On-going enrollment?

Yes

Program work is at your own pace–participants are uploaded when they complete the program requirements.

IACET program?

Yes

IACET Certificate has been submitted to Coordinator from Educator. (Educator pays for Program Application)

Is program restricted? *

Yes

If Yes, list any restrictions related to the program. (Restrictions may include: limited to a specific school, specific teacher group, etc.)

Restrictions *

This program can be offered up to six (6) times per year before a new application will need to be submitted. Please provide start and end dates and other locations (if applicable) for up to six offerings, within one calendar year.

Number of Offerings *

Offering 1

Start date *

Year

Month

Day

End date *

Year

Month

Day

Location/County Code

Offering 2

Start date *

Year

Month

Day

End date *

Year

Month

Day

Location/County Code

Offering 3

Start date *

Year

Month

Day

End date *

Year

Month

Day

Location/County Code

Offering 4

Start date *

Year

Month

Day

End date *

Year

Month

Day

Location/County Code

Offering 5

Start date *

Year

Month

Day

End date *

Year

Month

Day

Location/County Code

Offering 6

Start date *

Year

Month

Day

End date *

Year

Month

Day

Location/County Code

Is this program offered for College Conversion credit?

Yes

If yes, list college *

College contact and phone number *

Number of college credits offered *

Click to View Existing Evaluation Questions on the SCR

Question #	Existing Evaluation Questions on the SCR Please indicate on application if you wish to receive evaluation results for your program
1	The intended outcomes, as described for this offering, were accomplished.
2	The offering was organized so I had time to reflect on what I learned.
3	The presenters modeled effective questioning strategies and facilitation techniques to enhance my learning of content and/or skills.
4	The offering was organized so I had time to collaborate with colleagues and plan how to implement the new content and/or skills.
5	I feel confident in my ability to implement the new knowledge or skills gained in this offering in my current position.
6	Three specific ways I will implement the new knowledge or skills gained in my current position:
7	Three specific ways I will incorporate the new knowledge or skills gained into conversations with my colleagues:
8	Additional resources or support I need to incorporate the new knowledge or skills into collegial conversations and/or improve my work in my current position:
9	I feel confident in my ability to use the new knowledge and/or skills gained in this offering to improve my instructional effectiveness.
10	The subject-matter and/or pedagogical (teaching strategies) content was aligned with state content expectations for my grade level.
11	The subject-matter and/or pedagogical (teaching strategies) content was appropriate to my teaching needs and grade level.
12	The subject-matter and/or pedagogical (teaching strategies) content will contribute to my learning community’s attention to plans for improving instructional effectiveness.
13	The subject-matter and/or pedagogical (teaching strategies) content was aligned with my school’s goals for professional development, as part of the School Improvement Plan.
14	The subject-matter and/or pedagogical (teaching strategies) content was aligned with state academic achievement standards.
15	The subject-matter and/or pedagogical (teaching strategies) content will contribute to my use of student performance data to improve my instruction or administrative skills.

Do you wish to include extra questions for the online participant evaluation?

Yes

Extra Evaluation Questions

We encourage program specific questions on the online evaluation. We will send a copy of the results if you choose to include extra questions. Add up to five (5) extra questions (one per line) below.

Presenter name(s) *

Title

Affiliation (company/institution)

Please attach a single file containing the following 4 or 5 items:

Program objectives
The learning outcomes for your program
A final agenda for the program
The presenter's expertise/qualifications related to the program/training
If applicable, college credit statement

Outcome statements typically specify the knowledge, skills, or attitudes learners will acquire and be able to demonstrate during or following the learning experience. Learners should be aware of these intended learning outcomes prior to and during the activity.

The agenda must show specific training subjects. It must also include break times (10-15 minutes for every 2.5 hours of instruction) and meal breaks (full day sessions should include a 30-60 minute lunch period). Any agenda or program changes must be approved by WMU before the first day of the program via written request.

Please Note: Agendas must reflect the number of hours indicated for the program, excluding breaks. Once the program is approved, you and/or your presenter must run the program according to the final agenda submitted with this application. This means there can be no changes to the program agenda. As an example, a presenter or administrator cannot:

Skip breaks to allow early release.
Shorten the lunch break to allow early release.
Change the start time.
Make the end time earlier (if you run over that’s okay)
Change program dates without prior approval from the Sponsor.

You must attach in writing a statement from the college that the college is aware of, and approves, the program being offered for SCECHs. Following the program, the instructor must provide in writing the names of all participants that fully met all program requirements.

Attachment *

Files must be less than 5 MB.
Allowed file types: pdf doc docx odt.

Originating district (if not the approved sponsor)

Program Administrator *

Contact email *

Contact phone *

Acknowledge fee *

I acknowledge there is a $35 fee due with this application.

Advisory: It is a criminal offense to use or attempt to use a SCECH transcript or certificate of completion that is fraudulently obtained, altered, and/or forged to obtain and/or maintain school administrator, teacher and/or school psychologist certification or other State Board approval.

Payment Method *

Credit Card

WMU-Internal using FCC/JES

Mail a Check

*Please note: Credit card transactions can no longer be processed over the phone. We apologize for any inconvenience.

Pay Now

IMPORTANT: After clicking the yellow Pay Now button, you must click the green Submit button below in order to ensure that your application is submitted along with your payment. The yellow Pay Now button is for submitting payment only. Your full application is submitted by clicking the green Submit button on this page.

WMU program FCC for JES *

Checks should be made payable to: Western Michigan University

Please mail a check with your total amount due within 7 days of this application to:

Western Michigan University
1905 W Michigan Ave
c/o Carol Bale
3245 Ellsworth Hall
Kalamazoo MI 49008-5230 USA

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