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PDP Goal Approval Form: Initial Educators Only

This document is an instruction form for educators in Wisconsin to have their Professional Development Plan goals approved by their PDP team. It provides instructions for educators to complete part 1 with their information and goals, and for PDP team members to complete part 2 by reviewing the goals, signing off on their approval or denial, and returning the form to the educator. The form collects contact information for the educator and PDP team members, as well as licensing details, goal submission date, and signatures to affirm the accuracy of the information and decision on goal approval.

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phirlayayadil
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31 views

PDP Goal Approval Form: Initial Educators Only

This document is an instruction form for educators in Wisconsin to have their Professional Development Plan goals approved by their PDP team. It provides instructions for educators to complete part 1 with their information and goals, and for PDP team members to complete part 2 by reviewing the goals, signing off on their approval or denial, and returning the form to the educator. The form collects contact information for the educator and PDP team members, as well as licensing details, goal submission date, and signatures to affirm the accuracy of the information and decision on goal approval.

Uploaded by

phirlayayadil
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Wisconsin Department of Public Instruction

PDP GOAL APPROVAL FORM

INSTRUCTIONS TO EDUCATOR: Complete Part I and submit to your


PDP Team members for signature.
INSTRUCTIONS TO PDP TEAM MEMBER: Complete Part II and
return to educator.

PI-PDP-3 (Rev. 03-14)

Initial Educators Only

Professional Development Plan (PDP) forms available at: http://tepdl.dpi.wi.gov/pdp/writing-a-pdp


I. EDUCATOR INFORMATION
Educator Name

Educator E-Mail Address

Educator File / Entity No.*

Date Goal Submitted to PDP Team

Licensure Category

Teacher

Administrator

Pupil Services

I HEREBY CERTIFY THAT, by my signature below, under penalty of perjury, that the information submitted by me in this form is true. I am aware that
submitting false information in connection with this process may result in non-approval and/or non-renewal of a license and may subject me to civil or
criminal penalties.
Educator Signature

Date Signed Mo./Day/Yr.

II. PDP TEAM MEMBER INFORMATION


Team Member Name

Team Member E-Mail Address

Date Trained As a team member

Representing Check one


Teacher

Educator File / Entity No.*

Check One
Pupil Services

Administrator

IHE

Goal Approved
Not Approved

I HEREBY AFFIRM, by my signature, that the information provided is true and correct.
Signature

Date Signed Mo./Day/Yr.

Team Member Name

Team Member E-Mail Address

Date Trained As a team member

Representing Check one


Teacher

Educator File / Entity No.*

Check One
Pupil Services

Administrator

IHE

Goal Approved
Not Approved

I HEREBY AFFIRM, by my signature, that the information provided is true and correct.
Signature

Date Signed Mo./Day/Yr.

Team Member Name

Team Member E-Mail Address

Date Trained As a team member

Representing Check one


Teacher

Educator File / Entity No.*

Check One
Pupil Services

Administrator

IHE

Not Approved

I HEREBY AFFIRM, by my signature, that the information provided is true and correct.
Signature

Goal Approved

Date Signed Mo./Day/Yr.

*Educator file / entity numbers may be found on the DPI Educator License lookup at: http://tepdl.dpi.wi.gov/licensing/elo-public-search

Note: The initial educator must have this form completed and signed by the PDP team. Retain one copy for your
own records and present it to your team along with your completed plan for verification.

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