Directions: For each professional development activity for which renewal PD Hours are awarded, complete this template (or an
electronic format) and keep in your records along with the attendance list. This will be useful for State auditing purposes.
1. Describe the activity.
Write a statement showing the relationship between the content of the PD activity, specic relevant standard(s), and at least
one of the following criteria established for PD activities:
Engages participants over a sustained period of time allowing for analysis, discovery, and application as they
relate to student learning, social or emotional achievement, or well-being; or
Aligns to the licensee’s performance (evaluation); or
Includes outcomes that relate to student growth or district improvement; or
Aligns to State-approved standards; or
Are college courses.
3. Explain the intended impact on student learning or well-being.
ISBE 73-58 (5/15) Provided by the Illinois State Board of Education, Educator Licensure Division, Springeld, Illinois
Use your "Mouse" or "Tab" key to move through the fields and check boxes. After completing last field, save document to hard drive to make future updates or click print button.
Your school District
Observation Activity
Teachers had the opportunity to observe another educator in order to increase effectiveness in their own classroom. This
activity will increase participants knowledge and allow him/her to better utilize this program or skill in their classroom.
This professional learning activity will address our district improvement goal of insuring cohesiveness between grade levels.
More effective teaching strategies will be learning and this in turn should lead to student growth.
As students move through grade levels, it is important for students to have continuity. Students will be exposed to educators
with more experience and confidence in their academic area.
4. Identify any of the following criteria that apply to this PD activity:
Increases the knowledge and skills of school and district leaders who guide continuous professional development; or
Improves the learning of students; or
Deepens educators content knowledge; or
Uses learning strategies appropriate to the intended goals; or
Organizes adults into learning communities whose goals are aligned with those of the school and district; or
Provides educators with research-based instructional strategies to assist students in meeting rigorous academic
standards; or
Prepares educators to appropriately use various types of classroom assessments; or
Provides educators with the knowledge and skills to collaborate; or
Prepares educators to apply research to decision-making.
5. Identify the professional development standards to which the activity aligns:
Learning Communities - committed to continuous improvement, collective responsibility, and goal alignment.
Leadership - skillful leaders who develop capacity, advocate, and create support systems for professional learning.
Resources - requires prioritizing, monitoring, and coordinating resources for educator learning.
Data - uses a variety of sources and types of student, educator, and system data to plan, assess, and evaluate
professional learning.
Learning Designs - integrates theories, research, and models of human learning to achieve its intended outcomes.
Implementation - applies research on change and sustains support for implementation of professional learning for long-
term change.
Outcomes - aligns its outcomes with educator performance and student curriculum standards.
6. Attach the attendance list or keep this template with the list in electronic format.
7. Keep the evaluation forms in hard copy or electronic format with the template and attendance list.
8. Maintain a master Evidence of Completion form.
ISBE 73-58 (5/15) Provided by the Illinois State Board of Education, Educator Licensure Division, Springeld, Illinois
Reset Form