OFFICE OF SUPERINTENDENT OF PUBLIC INSTRUCTION
Professional Certification
Old Capitol Building, PO BOX 47200
Olympia WA 98504-7200
(360) 725-6400 TTY (360) 664-3631
Web Site: http://www.k12.wa.us/certification/
E-Mail: cert@k12.wa.us
ANNUAL PROFESSIONAL GROWTH PLAN (PGP) VERIFICATION
CONTINUING EDUCATION CREDIT HOURS
(CLOCK HOURS) AND PGP EQUIVALENCY
Use this form to verify completion of Professional Growth Plan as referenced in WAC 181-79A-030 and to verify continuing
education credit hours (clock hours) earned through WAC 181-85-075 and WAC 181-79A-251.
WAC 181-85-075
(2) Individuals holding a valid continuing certificate in subsection (1) of this section may choose to renew the certificate via annual
professional growth plans developed since the certificate was issued. Professional growth plans are defined in WAC 181-79A-030
.
WAC 181-79A-251
(f) Until June 30, 2018, individuals who complete the requirements of the annual professional growth plan to renew their certificate shall
receive the equivalent of thirty hours of continuing education credit hours. Beginning July 1, 2018, individuals who complete an annual
professional growth plan to renew their certificate shall receive the equivalent of twenty-five continuing education credit hours.
SECTION I
TO BE COMPLETED BY APPLICANT
1. NAME LAST FIRST MIDDLE
4. SOCIAL SECURITY NO. (OPTIONAL)
BUSINESS HOME
PERIOD DURING WHICH CLOCK HOURS WERE EARNED: TO
The individual indicated above has successfully completed a Professional Growth Plan as outlined in WAC 181-79A-030. Each completed
annual PGP prior to 7-1-18 shall receive the equivalent of thirty (30) continuing education credit hours (clock hours). Each completed
annual PGP after 7-1-18 shall receive the equivalent of twenty-five (25) continuing education credit hours (clock hours).
I declare under penalty of perjury under the laws of the State of Washington that I have completed the professional growth plan and
submitted evidence to that effect. The intentional misrepresentation of a material fact in this form subjects the certificate holder to
revocation of his/her certificate pursuant to chapter 181-86 WAC.
Educator Signature (required) Print Name Date
Individuals completing this form earn the clock hours as referred to above and must retain this form as documentation of hours earned.
Credits earned by certificate instructional staff after September 1, 1995, must satisfy the criteria in the reference listed below in addition to
criteria found in WAC 393-121-255 and WAC 392-121-259, shall be eligible for application to the salary schedule developed by the
legislative evaluation and accountability program committee only if the course content meets requirements of RCW 28A.415.023 and WAC
393-121-262.
FORM SPI 1128-8 (Rev. 8/18)
