Name:       	Submission Date:       	
Job Title:       	
Work Assignment / Location:       	
Home Address:       	
City:       	State:       	Zip:       	

Licenses that will be covered by this IPDP	
License Name 
(e.g. Elementary 1-8)	Educator ID	Issue Date	Expiration Date	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	

Plan Type: 		  Initial Proposal		  Revised Proposal	
Requested IPDP Effective Date*:       	

Goals: List 3-5 professional development goals. 

All educators should thoughtfully consider the goals they write on their Individual Professional Development Form (IPDP) taking into consideration 1) a process of self-assessment on their individual strengths and weaknesses using the Ohio Program Standards as a framework; 2) the priorities of their school/district; 3) the needs of their job; and 4) specific career goals. All goals on the IPDP should be written as SMART Goals. 

Ohio Educator Licensure Program Standards for Hearing Impaired Teacher Licensure: 
•	Message Content: Interpreters apply knowledge and identify resources to access a wide range of academic and world knowledge necessary to interpret in a variety of school settings.
•	Learning Environment: Interpreters support learning environments that promote high levels of learning and achievement for all students.
•	Interpretation: Interpreters prepare and deliver effective interpretation that supports instruction, assessment and the learning of each individual student.
•	Collaboration and Communication: Interpreters collaborate and communicate with members of the educational team regarding issues related to interpretation and hearing loss to support student learning.
•	Professional Responsibility and Growth: Interpreters assume responsibility for professional growth, conduct, performance and involvement as an individual and as a member of the learning community.	
Goal 1:       	
Goal 2:       	
Goal 3:       	

Goal 4:       	
Goal 5:       	
Activities you will use to complete these goals:       	
How do your goals relate to the Ohio Program Standards?       	
How do your goals relate to the priorities of your school/district?       	

DO NOT MARK BELOW THIS LINE. FOR LPDC USE ONLY.
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Approved IPDP Effective Date*:        
* The effective date of the IPDP can be the same as the issue date of the license only if IPDP is submitted within 3 months of the license issue date. New employees must submit an IPDP within three months of the first date of employment to use their first contract day as the effective date of the IPDP. 

An approved IPDP must be on file with the LPDC prior to beginning any professional development for the current license cycle. No professional development completed before the effective date of the IPDP will count towards license renewal. 

Effective Professional Development should:
•	Be selected based on analysis of data as well as individual and system goals.
•	Occur over one or multiple sessions, with long-term focus and follow-up.
•	Focus on the day-to-day work of educators (school-based and job-embedded).
•	Be content-specific and individualized.
•	Make use of internal expertise.
•	Be delivered in varied modes, including through learning communities or teacher teams. 
•	Focus on implementation of new approaches.
•	Include evaluation of providers and participants.
•	Focus on sustaining change over time, supported by continuous feedback

Approval Signature_________________________________ Date________________________