Appendix D:

LIST OF LPDC FORMS AND WHEN TO USE AND SUBMIT (All forms are available on the LPDC website)

LPDC FORMS
	
Form Name
	Purpose
	Submit to LPDC
	
Individual Professional Development Plan (IPDP)

(Note: a separate IPDP form for those employed as a teacher, counselor, school psychologist, interpreter, treasurer or administrator is available on the LPDC website. There is also a general form for those who do not work in those positions but who hold ODE licenses.
	•	To create a long term professional development plan that reflects goals for professional growth

•	To guide choices of professional development activities

•	Revisions can be submitted when job assignment changes or professional development needs change
	•	 As soon as a new license is issued

•	 Before beginning professional development activities that you want to count towards license renewal
	
Professional Development will not count towards license renewal unless the LPDC has approved your IPDP.

Request for Pre-Approval of Professional Development Activity

(Note: separate forms for teachers and nonteaching staff are available on the LPDC website)
	•	To request pre-approval for a professional development activity. See Handbook for activities that require pre-approval
	•	 Before beginning the activity
	
Evaluation of Pre- Approved Professional Development

(Note: separate forms for teachers and nonteaching staff are available on the LPDC website)
	•	Document and reflect on activities that require LPDC pre-approval

•	To receive CEU/contact hour credit for preapproved projects
	•	Upon completion of activity
	
Activity Log
	•	To document hours spent on an individual project that is ongoing and does not provide a contact hour certificate
	•	 Submit with Evaluation of Pre-Approved Professional Development upon completion of activity

•	 If activity did not require preapproval, submit with other license renewal documents as a form of documentation for the LPDC

LPDC FORMS
	
Form Name
	Purpose
	Submit to LPDC
	
Online Learning Environment Professional Development Activity Log
	•	 To document any meaningful learning experience that staff members completed as a result of the pandemic that they would not have done otherwise if schools were business as usual
	•	 Submit with other license renewal documents as a form of documentation for the LPDC
	
Resident Educator Completion Form for Years 1 and 2
(Note: use the form for the current school year)
	•	To document completion of required Resident Educator Mentoring Activities

•	Must be accompanied by an Activity Log
	•	 Submit with other license renewal documents as a form of documentation for the LPDC
	
Webinar Participation Form Contact Hour Form
	•	To document activities that do not provide a contact hour certificate
	•	Submit with other license renewal documents as a form of documentation for the LPDC
	
PD Summary of Activities
(Note: separate forms for teachers and nonteaching staff are available on the LPDC website)
	•	To help organize and record professional development contact hours

•	Original certificates should be attached to this form
	•	 Submit with other license renewal documents as a form of documentation for the LPDC
	
Safe Schools Summary
(Note: it is possible in Safe Schools to print a list of all courses completed rather than the individual certificates. Make sure the time frame is consistent with the dates of the approved IPDP.)
	•	To record Safe Schools courses and convert minutes to contact hours

•	Original certificates or a Safe Schools transcript should be attached to this form
	•	 Submit with other license renewal documents as a form of documentation for the LPDC
	
Final Checklist
	•	To request approval for renewal of a license from the LPDC
	•	Licenses may be renewed starting in November of the year before the certificate or license is due to expire.
	
Approval Verification Form For Educators Leaving a LPDC
	•	 Verify activities for a new employer if you are leaving the your job
	•	As soon as possible after the job change occurs

•	New hires to the ESC of Lake Erie West should submit the form from their previous LPDC as soon as possible after
	hire	

LPDC FORMS
	
Form Name
	Purpose
	Submit to LPDC
	
Appeal Request
	•	To appeal a decision of the LPDC

•	To ask for an exemption from an LPDC guideline
	•	As soon as a problem is apparent

•	Decisions of the LPDC must be appealed within 15 days of LPDC notification of decision