Teacher Education Credit Review Form
Use this form to submit teacher education credits or training for review and credit recognition.
Applicant Information
Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Role or Position
*
Please Select
Teacher
Instructional Coach
Administrator
Counselor
Specialist
Other
School or Institution Name
*
District / Organization
Credit and Course Details
Course or Program Title
*
Provider or Institution Name
*
Course or Credit Type
*
Please Select
Graduate Course
Undergraduate Course
Continuing Education Unit (CEU)
Professional Development
Workshop
Seminar
Conference
Online Course
Independent Study
Other
Credit Hours or Units
*
Completion Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Brief Description of Learning Activity or Course Content
*
Supporting Documentation
Completion Certificate
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Supporting Evidence
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Review Request and Evaluation
Reason for Review
*
Requested Credit Outcome
*
Please Select
Approve full credit
Approve partial credit
Request more information
Deny credit
Reviewer Decision
*
Approve
Request more information
Deny
Reviewer Comments
Submit Review
Should be Empty: