Annual Professional Growth Plan (Pgp) Verification Continuing Education Credit Hours (Clock Hours) And Pgp Equivalency

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OFFICE OF SUPERINTENDENT OF PUBLIC INSTRUCTION
Professional Certification
Old Capitol Building, PO BOX 47200
Olympia WA 98504-7200
(360) 725-6400 TTY (360) 664-3631
Web Site:
E-Mail: cert@k12.wa.us
ANNUAL PROFESSIONAL GROWTH PLAN (PGP) VERIFICATION
CONTINUING EDUCATION CREDIT HOURS
(CLOCK HOURS) AND PGP EQUIVALENCY
Use this form to verify completion of Professional Growth Plan as referenced in WAC 181-79A-030 and to verify continuing
education credit hours earned through WAC 181-85-075.
WAC 181-85-075
Individuals holding a valid continuing certificate may choose to renew the certificate via annual professional growth plans. Each
completed annual professional growth plan (PGP) shall receive the equivalent of thirty (30) continuing education credit hours.
SECTION I
TO BE COMPLETED BY APPLICANT
1. NAME
LAST
FIRST
MIDDLE
MAIDEN/FORMER NAME
2. ADDRESS
3. DATE OF BIRTH
CITY/STATE/ZIP
4. SOCIAL SECURITY NO. (OPTIONAL)
5. TELEPHONE:
6. E-MAIL
BUSINESS (
)
HOME (
)
PERIOD DURING WHICH CLOCK HOURS WERE EARNED:
TO
The individual indicated above has successfully completed a Professional Growth Plan as outlined in WAC 181-79A-030. Each completed
annual PGP shall receive the equivalent of thirty (30) continuing education credit hours.
I declare under penalty of perjury under the laws of the State of Washington that I have completed the professional growth plan and
submitted evidence to that effect. The intentional misrepresentation of a material fact in this form subjects the certificate holder to
revocation of his/her certificate pursuant to chapter 181-86 WAC.
Educator Signature (required)
Print Name
Date
Individuals completing this form earn the clock hours as referred to above and must retain this form as documentation of hours earned.
Credits earned by certificate instructional staff after September 1, 1995, must satisfy the criteria in the reference listed below in addition to
criteria found in WAC 393-121-255 and WAC 392-121-259, shall be eligible for application to the salary schedule developed by the
legislative evaluation and accountability program committee only if the course content meets requirements of RCW 28A.415.023 and WAC
393-121-262.
FORM SPI 1128-8 (4/14)

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