Page 17 - Spring 2018 Catalog

(Continue on back)

My request meets the following criteria: (NOTE: In order for this request to be granted, the following MUST

apply):

1) The in-service is above/beyond the school day. (Professional leave, taken during the school day, does not

qualify.)

2) College credit is not part of the in-service.

3) The in-service is relevant to my teaching assignment. You must attach agenda, description or reflection.

4) There is no substitute cost incurred by Huber Heights City Schools.

Credit will not appear on the quarterly report until Proof/Certificate of attendance has been received.

Employee’s Signature:____________________________________________________________

Principal’s Signature: _________________________________________Date Received________

-------------------------------------------------------------------------------------------------------------------------------

Office Use Only:

Please return this signed form to:

Kim Wilder, Secretary to the Dept. of Curriculum and Instruction

Date received_____________

Approved_____________ Declined____________ ______________________________
Director of Curriculum and Instruction

This form will be returned to the staff member upon review and prior to the scheduled professional
development.

(Revised 3/17)

17