*Approval must be granted with both signatures obtained
as listed below prior to taking the alternative in-service.
DELAWARE VALLEY SCHOOL DISTRICT
Request for Pre-Approval of Professional Education Hours
To be Used Toward Alternative In-service
Employee
Name:
Today’s
Date:
Employee Building:
Area of Certification:
Name of PDE Approved Provider:
Name of Program:
Date of Program:
Time of Program:
(ACTUAL SEAT TIME ONLY)
Program Description:
(Program must be
related to current
teaching field or area
of certification)
YES
NO
Written documentation of attendance
Related to teaching field
Hours used toward alternative in-service
Routing Order and Signatures:
Principal’s Signature
Approves Request
Denies Request
Date
Professional Education Coordinator’s Signature
Approves Request
Denies Request
Date