Request for Event Approval

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If you are planning a professional development event and would like to provide clock hours to your attendees, please complete the following form. Your responses will be submitted to the WSASP board for approval. The result of board decision will be emailed to you from the WSASP Clock Hour Chair, Amanda Fleck. Thank you!

Requestor email: *

Requestor name: *

Event title: *

Event date(s): *

Start time: *

Time

End time: *

Time

Event audience/invited guests: *

Estimated number of attendees: *

Location of event: *

Event sponsor: *

Brief summary of the event: *

Learner Objective 1 (Please include which NASP domain this objective corresponds to): *

Learner Objective 2 (Please include which NASP domain this objective corresponds to): *

Learner Objective 3 (Please include which NASP domain this objective corresponds to): *

If not done so in previous items, please include all NASP domains that your proposed event will include. *

Provide information about the credentials/expertise of each presenter in the professional development or provide a link to this information *

How many clock hours are you requesting to be offered? *

WSASP requires all events to meet the minimum requirements below before consideration for clock hour approval. Please acknowledge that: *

This event is not a business meeting.

This event provides meaningful professional development for school psychologists.

This event is at least one hour in length.

This event provides professional development relevant for school psychologists and beyond the district level, including EITHER outside speakers OR outside attendees. District level trainings that do not include either an outside speaker or outside attendees are encouraged to seek approval for district-offered clock hours (not WSASP clock hours).

This request is prior to the commencement of the event.

I must submit a copy of my event attendees to the clock hour chair upon conclusion of my event.

Required

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