Byron-Bergen Central Schools request for IN-SERVICE CREDIT PRIOR APPROVAL

Submit this completed form and course description to the Superintendent for approval.

Name:	Today's Date:

Title of Program:

Date(s) of Work:

Number of Service Clock Hours* (does not include meal time): *15 clock hours = 1 credit hour

Facilitator/Presenter:

Location:

Please discuss below how this course will enhance your content knowledge and/or instructional ability:

Teacher's Signature	Date

Approval:	Yes	No

Superintendent's Signature	Date

Copy to be given to Payroll/Attendance for notification purposes.

Form effective 7/1/17	Form Revised 9/10/19