Staff Development Registration Form

Name:
School/Division:
Position/Title:
Day/Office Tel. (xxx-xxx-xxxx):
Fax:
Email Address:
Have you been approved by your supervisor to attend this workshop?	Yes No
Name and/or Description of Workshop:
Date of Workshop: (xx/xx/xxxx)

Location: (For On Site Workshops Only)
Virginia Department of Education, James Monroe Bldg, (22nd floor), 101 N. 14th Street (14th and Franklin Sts.)
Must be prepared to present to the security guard a photographic identification (such as your driver's license) in order to enter the building.

Parking:
Public honor-pay parking lots - 15th and Main Sts. - rate = app. $5.00 for all day. No parking available in DOE/Monroe Bldg.

Re-certification Points:
Please discuss with your local school division to see if this activity will be accepted for points. A letter of attendance will be given to participants at the end of the session.

Target Audience:
Classroom teachers and curriculum specialists
Library Media Specialists
Technology Specialists