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< < DATE(S)DESCRIPTION OF INSERVICECONTACT TIME
SEMESTERCOLLEGECOURSE DESCRIPTIONCREDIT(S)
THE FOLLOWING MUST BE COMPLETED BEFORE SUBMITTING THIS FORM:
INSERVICE
DATE OF INSERVICE
DESCRIPTION OF INSERVICE
CONTACT TIME ROUNDED TO CLOSEST QUARTER HOUR
AGENDA ATTACHED
COLLEGE CREDIT
SEMESTER ATTENDED
COLLEGE ATTENDED
COURSE DESCRIPTION
CREDITS
GRADE CARD OR TRANSCRIPT ATTACHED
PARAEDUCATOR INSERVICE HOURS
NAME____________________________ SCHOOL______________________
A DESCRIPTION OF THE INSERVICE AND AN AGENDA MUST BE ATTACHED
A GRADE CARD OR TRANSCRIPT MUST BE ATTACHED
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