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Get NY 175 Professional Development Tracking Form

175 Professional Development Tracking Form Directions This form is provided for use by individuals holding a Professional Certificate. It should be used to track your progress in completing the 175 hours of professional development in accordance with certification requirements. Record your completed Professional Development activities in the table below. Upon completion of your activities submit this tracking form and back-up to your principal for approval principal must sign below. After receiving principal s approval forward only this completed and signed tracking form via fax to 718-935-2720 if you do not want to fax your form please mail the completed and signed tracking form to the New York City Department of Education Office of Certification and Licensing Attention 175 Hours of Professional Development 65 Court Street Room 801 Brooklyn New York 11201. It should be used to track your progress in completing the 175 hours of professional development in accordance with certification requirements. Record your completed Professional Development activities in the table below. Upon completion of your activities submit this tracking form and back-up to your principal for approval principal must sign below. Print Name Certificate Title File District/Borough/School Activity Provider Date s of Activity Start to Finish Number of Hours Obtained for Activity Total Number of Hours I have reviewed the completed professional development activities and I am in agreement with/ and approve the activities listed above. Date Signature of Certificate Holder Signature of Principal FAX TO 718-935-2720 OR MAIL TO ADDRESS ABOVE KEEP A COPY FOR YOUR RECORDS GIVE A COPY TO YOUR SCHOOL. Print Name Certificate Title File District/Borough/School Activity Provider Date s of Activity Start to Finish Number of Hours Obtained for Activity Total Number of Hours I have reviewed the completed professional development activities and I am in agreement with/ and approve the activities listed above. Date Signature of Certificate Holder Signature of Principal FAX TO 718-935-2720 OR MAIL TO ADDRESS ABOVE KEEP A COPY FOR YOUR RECORDS GIVE A COPY TO YOUR SCHOOL. .

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