Submitted by:        Date: 

School:

Name of Conference/Activity:

Dates & times of activities: (for conferences list all sessions attended with starting and ending times)

Summarize the information for each session/activity listed above:

As a result of this conference/activity, what will you implement in your classroom/role?

How will you share this information with your colleagues? 

Submit this form to the Assistant Superintendent within one week following the conference/activity