Today's Date 
        
     
    
         
    
    
        Your Full Name 
        
     
    
         
    
        
            Select One: 
 
                (required) 
                
        Help for Select One: 
     
    Additional offering: you are adding another date to a previously approved program 
         
        
            
                    
                        New - first time event is being offered 
                     
                    
                        Update - this is for an additional offering 
                     
             
         
     
    APPLICATION DETAILS 
    
        
            Please select from the following statements: 
 
                (required) 
            
         
        
            
                    
                        SCECHs for individual sessions in a series 
                     
                    
                        SCECHs upon completion of all sessions in a series 
                     
                    
                        This is a single event 
                     
             
         
     
    
        Program Title (cannot be changed once submitted) 
            
        Help for Program Title (cannot be changed once submitted) 
     
    Title can be no more than 35 characters including spaces. 
     
    
         
    
        
            Choose one: 
 
                (required) 
                
        Help for Choose one: 
     
    Hybrid: Program is a combination of face-to-face and virtual/online. Face-to-face: Participants physically attend the complete program. Virtual/Online: Complete program held through some type of virtual/online media 
         
        
            
                    
                        This is a blended/hybrid event 
                     
                    
                        This is a face-to-face event 
                     
                    
                        This a virtual/online event 
                     
             
         
     
    
        
            Same location as that of sponsor? 
 
                (required) 
                
        Help for Same location as that of sponsor? 
     
    Is the program being held at the sponsor's address (i.e., at MOISD)? 
         
        
            
                    
                        
                        Yes 
                     
                    
                        
                        No 
                     
             
         
     
    
        Event Location 
            
        Help for Event Location 
     
    If your event will not be held at the same location as MOISD, the event location name and address is required. 
     
    
        
     
    
        Category 
            
        Help for Category 
     
    Select the ONE that best describes your event. 
     
    
        (Please Select) 
Adult Education 
Agricultural Education 
Agriscience and Natural Resource 
Art Education 
Bilingual Education 
Business Education 
Career and Technical Education 
Committee/Review Team 
Communication Arts 
Computer Science/Technology 
Early Childhood 
Educational Technology 
English 
English as a Second Language 
Environmental Studies 
Family and Consumer Sciences 
Fine Arts 
Foreign Language 
General Studies 
Gifted/Talented 
Guidance and Counseling 
Heath/Recreation/Phys. Education 
Home Economics 
Humanities 
Industrial Technology 
Language Arts 
Library Media 
Mathematics 
Mentor Teacher/Principal 
Multi Age 
Music Education 
New Administrator Mentor (Non-Content) 
New School Psychologist Mentor (Non-Content) 
National Board Certification 
On-Line Courses 
School Committee 
Science 
Social Science 
Social Studies 
Special Education 
Technology/Design 
Visual Arts 
Vocational Agriscience and Natural Resources 
Vocational Education 
Vocational Health Sciences 
Vocational Human Services 
World Language and Culture 
Writing 
Elementary School (PreK-5) 
Middle School Level (6-8) 
Secondary School Level (9-12) 
Curriculum Development (Non-Content) 
Leadership Skills (Non-Content) 
Management/Supervision Skills (Non-Content) 
Miscellaneous (Non-Content) 
Multicultural Skills (Non-Content) 
New School Counselor Mentor (Non-Content) 
Parent and/or Community Relations 
School Administration (Non-Content) 
School Improvement (Non-Content) 
SP Rules & Procedures (Non-Content) 
Superivising School Counselor (Non-Content) 
Supervising School Pyschologist (Non-Content) 
Supervising Teacher (Non-Content) 
 
    
        Course Narrative 
            
        Help for Course Narrative 
     
    This is the description that will appear in the State course catalogue. Include basic information to let participant know what the program is about. 
     
    
        
     
    
        
            Prerequisites? 
 
                (required) 
                
        Help for Prerequisites? 
     
    If there is a program the participants must take prior to this program, please list below. If none, choose NONE. 
         
        
            
                    
                        Yes (please list below) 
                     
                    
                        None 
                     
             
         
     
    
        Prerequisites (if applicable) 
            
        Help for Prerequisites (if applicable) 
     
    If prerequisites are necessary, please list them here. 
     
    
        
     
    
        Participant Fee 
            
        Help for Participant Fee 
     
    If there is a fee to attend this event, please enter the dollar amount here. 
     
    
         
    
        Attendance Method 
            
        Help for Attendance Method 
     
    What will you use to verify that registrants are in attendance? (sign-in sheet, some type of assignment, game, handouts with names, etc) 
     
    
         
    
        Is this a conference? 
            
        Help for Is this a conference? 
     
    A conference has concurrent sessions & keynote. 
     
    
        (Please Select) 
Yes 
No 
 
    
        If this is a conference, enter the minimum number of hours available. 
            
        Help for If this is a conference, enter the minimum number of hours available. 
     
    For example: This is a 3-day conference where each session lasts 5 hours, but a participant doesn't have to attend every session. The minimum this participant can earn is 5 hours. 
     
    
         
    
        If this is a conference, enter the maximum number of hours available 
            
        Help for If this is a conference, enter the maximum number of hours available 
     
    Actual time of instruction. Do not include breaks, lunch, prep time or similar non-instructional activities. 
     
    
         
    
        Total Contact Hours 
            
        Help for Total Contact Hours 
     
    The actual time used for instruction. Do NOT count the welcome, breaks, lunch, dinner speeches, homework, prep time, registration, or similar non-instructional activities. 
     
    
         
    
        Enter up to two program descriptors from the PDF document to right. 
            
        Help for Enter up to two program descriptors from the PDF document to right. 
     
    You must select one, but no more than two. 
     
    
         
    
        On-going enrollment? 
            
        Help for On-going enrollment? 
     
    Program is work at your own pace - participants are uploaded when they complete the program requirements. 
     
    
        (Please Select) 
Yes 
No 
 
    
        
            Is Program Restricted? 
 
                (required) 
                
        Help for Is Program Restricted? 
     
    If YES, list any restrictions related to the program. Restrictions may include: limited to a specific school, specific teacher group, etc. 
         
        
            
                    
                        Yes (provide info below) 
                     
                    
                        No 
                     
             
         
     
    
        Program Restrictions (if applicable) 
            
        Help for Program Restrictions (if applicable) 
     
    Enter your program restrictions here. 
     
    
        
     
    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. 
    PROGRAM DETAILS 
    
        Number of program offerings 
            
        Help for Number of program offerings 
     
    How many times will this exact same program be offered/presented? 
     
    
         
    
        Beginning date 
        
     
    
         
    
    
        Ending date 
        
     
    
         
    
    
        Beginning date #2 
            
        Help for Beginning date #2 
     
    If this exact program will be offered more than once, enter in all the dates in the series here. 
     
    
         
    
    
        Ending date #2 
        
     
    
         
    
    
        Beginning date #3 
        
     
    
         
    
    
        Ending date #3 
        
     
    
         
    
    
        Times of Event 
            
        Help for Times of Event 
     
    For example: 8:30 AM to 3:00 PM 
     
    
        
     
    
        What are the learning outcomes and objectives for your program? (Please provide information on what participants will be able to do as a result of attending, and the overall purpose of the program.) 
        
     
    
        
     
    COLLEGE CONTACT DETAILS 
    PROGRAM CONTACT 
    This area contains the contact information and website for the person that participants would contact to get more information about this specific program. 
    
        Who will serve as program monitor (full name please) 
            
        Help for Who will serve as program monitor (full name please) 
     
    The program monitor is typically the person completing this form. 
     
    
         
    
        Monitor's email 
        
     
    
         
    
        Monitor's phone # 
        
     
    
         
    
        Program website (if applicable) 
            
        Help for Program website (if applicable) 
     
    If you would like your program details to include a website for participants to view, please include it here. 
     
    
         
    
        Originating district (if applicable) 
            
        Help for Originating district (if applicable) 
     
    If you are not an employee of MOISD (you are having us sponsor your event), please list your district here. 
     
    
        
     
    EVALUATION 
    
        Do you wish to include extra questions in the online Participant Evaluation? The State encourages program-specific questions. These (up to five) can be in any format and added to the standard online evaluation. The Standard Evaluation questions can't be changed and will always go to participants. This is an offer to add your own. Please list up to five below. 
        
     
    
        
     
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