THE TEACHER CENTER of Broome County

Professional Development for Teachers

2007-2008

Program Request Form

Please use this form if you would like to request that a Teacher Center workshop be offered at your school site. Please read the relevant policy listed below before filling out the Program Request Form.

If a practicing teacher asks the Teacher Center to arrange a training (after school) the usual $5 per person registration fee will be charged for every three hours of training and the Teacher Center will pay all the instructor fees and mileage plus provide the materials. A minimum of 8 consortium members must register in order for the training to be held.

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If a district administrator or the mentor coordinator hired by the district asks the Teacher Center to arrange a training (full day or after school) the district will be billed for ½ of the total cost (no less than $5 per person plus mileage) and the Teacher Center will pay the other half (no more that $500). A minimum of 8 consortium members must register in order for the TC to pay ½ of the fee. If less than 8 register the district can opt to still hold the training and pay the entire fee.

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Main Contact Person:

District:

School:

School Phone:

Subject /Grade Taught of Targeted Audience:

Home Phone:

How many hours of training are you requesting?

E-Mail Address (only if you read it):

Requested Location:

What program would you like offered at your site?

How many people will probably attend? The minimum amount is 8 people.

PLEASE NOTE: A room must be available at your site and equipment must be provided for the presenter i.e. overhead projector, television, VCR, chart etc.

Requested date:

Alternate date:

What kind of in-kind support will you be receiving? (In-kind support means goods and services provided at no cost to you. These can be professional services, supplies, space or material donations or the use of equipment.

Would you like to request or recommend a specific instructor?

Yes

If you answered YES, please list contact information below.

Name:

Phone:

E-Mail Address (if they read it):

PLEASE NOTE: We pay our instructors a stipend and mileage so please be aware that there is a minimum enrollment set for each workshop. The number is usually 8 people.

Applications are due a minimum of 30 calendar days before the requested date. Requests will be accepted until April 30, 2008 or until all funds are committed.


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