Office of the Superintendent for Public Instruction

Professional Education and Certification

Old Capitol Building, FG-11, Olympia WA 98504-3211

360-725-6400

CONTINUING EDUCATION AND VOCATIONAL CLOCK HOURS

PRIOR NOTICE

Approved continuing education providers must submit this form and required information 30 days in advance of any offering (10 days if a previously approved program is to be offered at a different location) to: Professional Education and Certification, Superintendent of Public Instruction, Old Capitol Building, FG-11, Olympia, WA 98504-3211 -OR- Approved provider: Auburn School District, 915 Fourth Street NE, Auburn, WA 98002.

SCHOOL/LOCATION:

Type of Plan (Please circle one): PDM LID Other

1. SPONSORING PROVIDER NAME*
Auburn School District
/ 2. SPONSORING PROVIDER ADDRESS

James P. Fugate Administration Bldg. 915 Fourth Street Northeast

Auburn, WA 98002
3. TITLE OF OFFERING
4. DAYS OF OFFERING / 5. TIME OF OFFERING / 6. NUMBER OF CONTINUING
CLOCK HOURS
7. NAME OF INSTRUCTOR(S)
/ 8. WRITTEN OBJECTIVES ATTACHED
q YES q NO
9. QUALIFICATIONS OF INSTRUCTOR ATTACHED
q YES q NO / 10.   REQUESTING APPROVAL FOR VOCATIONAL
CLOCK HOURS
q YES q NO
11.   Does the course content include STEM content? q YES q NO
12. EVALUATION FORM**
q ATTACHED q PREVIOUSLY SUBMITTED
Must include:
1.  extent to which written objectives have been met
2.  quality of the physical facilities
3.  quality of the oral presentation by each instructor
4.  quality of the written materials provided by each instructor
13. WILL CANDIDATES HAVE THE OPTION OF USING
THIS OFFERING FOR COLLEGE OR UNIVERSITY
CREDIT?
q YES q NO / 14. IF YES, NAME COLLEGE OR UNIVERSITY

*If items 1 through 8 are included on the program agenda, that agenda may be submitted or attached

to this form in lieu of written responses to items 1 through 8.

**If a continuing education provider is using the same evaluation form for all activities, submission

of the evaluation form will only be required for the first program.