District \ Parent \ Township Institute Application

Fields marked with an asterisk (*) are required.

Application For:* Please Select a Application type.

District Name / Number:* Please Select Your District.

Number of Participants:* Number of Participants is a required field.

Date of Institute:* Required Field

To Be Held At(Facility, City, State):* Location is a required field.

PLANNING COMMITTEE MEMBERS: (50% must be classroom teachers, 25% administrators and 25% school service personnel.)

Teachers - 50%:

Administration - 25%:

School Service Personnel - 25%:

Theme of District Institute:* Theme is a required field.

Institute Day Objectives:* Objectives are a required field.

If you are providing professional development (PD) hours for any part of this Teacher Institute, you must also fill out and keep on file a copy of the
“Approved Professional Development Provider Activity Summary (73-58)”.
https://www.isbe.net/Documents/73-58-approved-pd-provider-activity-summary.pdf

Chairperson of Planning Committee (Name):* Chairperson of Planning Committee is a required field.

Date:* Required Field

District Superintendent:* Superintendent is a required field.

Date:* Required Field

Agenda Upload:* (2MB Limit for Upload) Required Document.

Email for Confirmation of Receipt

Enter Email:* Required Field.

Additional Emails for Receipt

If there is anyone else you would like to receive a copy of this application and follow up emails, please enter them below.

Email: