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Why NJEA
Careers in Education
Preservice
Early Career
Educational Support Professional
Higher Education
NJREA Member
Public Charter Members
Member Benefits
Issues
Action Center
Pensions & Health Benefits
High-Stakes Testing
Affordable Healthcare
Evaluation
Health & Safety
Anti-Bullying
Public Charter Schools
Events
Community
Family Involvement
Partnerships & Contests
Teacher for a Day
Pinch Hit for ESP
Read Across New Jersey
Learning
Classroom Tools
Professional Learning
Advocacy Training
NJEA Convention
Grants
Hipp Foundation
PRIDE
Other Grants
About
Mission
History
Leadership
Press Room
Regional Offices
Jobs
Contact NJEA
Review
Classroom Close-up, NJ
Affiliated Groups
Good News about New Jersey’s Public Schools
Center for Future Educators
NJ Center for Teaching & Learning
Learning
Professional Learning
PD Provider Form
PD Provider Form
The application will be reviewed by the NJEA Professional Development Institute. If approved, a short description will be placed in the Showcase column of the NJEA Review publication as well as on our website. It must be submitted 120 days prior to registration deadline for the NJEA Review and website, or 60 days prior to registration deadline for posting on the website only.
For questions
Login to Contact Mike Ritzius
or call 609-599-4561, ext. 2807, or
Login to Contact Brielle Allison
or call 609-599-4561, ext. 2259.
Title of workshop/conference/course
Event Name
*
Date
*
Date Format: MM slash DD slash YYYY
Location
Registration Information
Name
*
First
Last
Email
*
Phone
*
Fax
Registration fee $
*
Payable to
Registration begins
Date Format: MM slash DD slash YYYY
Registration ends
Date Format: MM slash DD slash YYYY
Online registration
*
Yes
No
Web Address
Organization Information
Name of sponsor / organization
Contact Person
First
Last
Business address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
Website
Phone
Fax
Event Information
Target audience
Grade level(s)
Instructional/Content Area
Is the activity appropriate for release time?
Yes
No
Will the activity be held outside of school time?
Yes
No
Will the workshop or participants be recorded in any way?
Yes
No
Would you be willing to sponsor a member of the NJEA Professional Development Committee to participate in your event?
Yes
No
Will there be any other materials sold at the event?
Yes
No
The sponsoring organization is
Profit
Non-profit
Attachments
Please attach any documentation with your application such as
Synopsis of program content/agenda
Conference speakers and topics
Pictures (Presenters/past conferences)
Promotional materials
Upload files
Drop files here or
Other
Explain what provisions are available
Facilities are handicap accessible?
Yes
No
Comment
Will snacks and/or meals be available?
Yes
No
Comment
Can special dietary needs be met?
Yes
No
Comment
Activity checklist
Check all that apply
Check all that apply
Coaching
Collegial collaboration
Course online
Course on-site
Curriculum writing
Demonstration
Feedback/follow-up
Hands-on activity
In-depth learning (demonstration, theory, practice with feedback)
Lecture/motivational speech
Mentoring
Modeling
Observation/assessment
Online discussion
Practice under simulated conditions
Practice with feedback
Structured training (theory, demonstration, practice under simulated conditions)
Study group
Other
Other (please specify)
Activity Data
Please complete the following
Describe the purpose/content of your activity in 200 words or less
Explain how your event relates to the New Jersey Student Learning Standards
Describe your process for self-evaluation
Would you be willing to make the results of that evaluation available to NJEA?
Yes
No
Agreement
I certify that the activity for which endorsement is sought is consistent with the spirit of Association policy and programs. I agree that the sponsoring organization
will distribute certificates to each participant for Professional Development hours, if applicable.
(enter hours)
Title of Sponsoring Organization
Please note
The questions on this application help the Professional Development Committee obtain a better understanding of the provider and the program being submitted and do not necessarily disqualify an applicant.
Signature
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