Date Completed # of PDUs
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Employee Signature: Date:
Admin Signature:
Domains:
Please use the appropriate corresponding number above under domain(s)
1 = Learning communities 3 = Resources 5 = Learning designs
2 = Leadership 4 = Data 6 = Implementation
For more info concerning domains, see OAR 584-090-0110
Counting PDUs Minimum number required:
One clock hour = one PDU 75 for final 3-year licenses
125 for final 5-year licenses
Substitutes and Less than .50 FTE cannot use this form
One college credit = 20 PDUs
(quarter calendar)
One college credit = 30 PDUs
(semester calendar)
Educator’s Name: _______________________
7 = Outcomes
Admin Name:
Domain(s) Activity Name
Emp. ID #: ____________
Log of Professional Development Activities
Total Number of PDUs =
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