ISBE 73-08 (1/21)
APPLICATION FOR STATE PROFESSIONAL
DEVELOPMENT PROVIDER
EDUCATOR EFFECTIVENESS DEPARTMENT
Organizations eligible to apply to the Illinois State Board of Education to become Illinois State-approved professional development
providers are Illinois non-profit, professional educator associations representing one or more of the following groups, A) school
administrators, B) principals, C) school business officials, D) teachers (including special education teachers), E) school boards, F)
school districts, G) parents, or H) school support services personnel. Please include a signed IRS W9 Request for Taxpayer
Identification Number and Certification (www.irs.gov/pub/irs-pdf/fw9.pdf) with the application.
Entities that do not meet the criteria to become an Illinois State-approved provider, but wish to provide professional development
services in Illinois, may do so in collaboration with any Illinois State-approved professional development provider, under that entity’s
approval. A list of Illinois State Approved Professional Development Providers is available on the Illinois State Board of Education
website at https://www.isbe.net/Documents/prof-dev-provider-list.pdf.
PRINT OR TYPE NAME OF ORGANIZATION APPLYING FOR APPROVAL
ADDRESS OF ORGANIZATION (STREET, CITY, STATE, ZIP CODE)
NAME OF CONTACT PERSON RESPONSIBLE FOR PROFESSIONAL DEVELOPMENT
CONTACT TELEPHONE NUMBER (Include Area Code) CONTACT E-MAIL ADDRESS
As an approved professional development provider, I confirm that this organization will do all of the following:
I understand that the State Superintend
ent of
Education will review the annual data collected by the State Board of Education to
determine if my organization has met the criteria and should continue to be an approved provider or if further action should be taken.
Signature of Person Responsible for Professional Development Title
Date
Signature of Head of Organization Title
Date
100 North First Street, E-240
Springeld, Illinois 62777-0001
SUBMIT THIS FORM AND ALL REQUIRED
DOCUMENTATION TO PDProvider@isbe.net
1. Align professional development activities to the State-approved national standards for professional learning promulgated by
Learning Forward, 504 South Locust Street, Oxford OH 45056 and posted at
https://learningforward.org/standards-for-professional-learning/?_ga=2.138336501.413293456.1611336082-25639789.1611239002
2. Produce a rationale for each activity that explains how it aligns to Illinois State standards (Illinois Administrative Code, Section
1. Appendix D State Goals for Learning – Illinois Professional Teaching Standards - 2013) and identify the assessment for
determining the expected impact on student learning or school improvement;
3. Maintain original documentation for completion of activities (participants’ lists, sign-in sheets, ISBE 77-21A Evaluation form,
4. a completed master copy of the ISBE 77-21B Evidence of Completion form; a completed ISBE 73-58 Approved Professional
Development Provider Activity Summary) for a period not less than six (6) years;
5. Provide license holders with ISBE 77-21B Evidence of Completion forms for all activities; and
6. Annually submit to the State Board of Education a list of subcontractors used for delivery of professional development activities
7. for which renewal credit was issued (ISBE 73-59 Annual Approved Provider Report).
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