Program Title *

Have you submitted an application for this program/event/experience in the past? *
- Select Option Yes No

If yes, and *NOTHING HAS CHANGED*, please put the program approval number here.

Program Format *
Face-to-Face - Participants physically attend
Blended/Hybrid - Program is a combination of Face-to-Face and Virtual/Online
Virtual/Online - Program is completely held through a live, virtual format
Self-Paced, Asynchronous, On-Demand - Program is completely self-paced and held via a virtual format

Event Location (business/school name, building name, and/or room number) *

Address *

City *

Zip Code *

Category (select most applicable option) *
- Select Option Adult Education Agricultural Education Agriscience and Natural Resources Armed Forces Service Art Education Bilingual Education Business Education Career and Technical Education Committee/Review Team Communication Arts Computer Science/Technology Curriculum Development (Non-Content) Early Childhood Educational Technology Elementary Level (Grades PreK-5) English English as a Second Language Environmental Studies Family and Consumer Sciences Fine Arts General Studies Gifted/Talented Health/Recreation/Physical Education Home Economics Humanities Industrial Technology Language Arts Leadership Skills (Non-Content) Library Media Management/Supervision Skills (Non-Content) Mathematics Middle School Level (Grades 6-8) Miscellaneous (Non-Content Area) Music Education School Counseling School Improvement (Non-Content) Science Social Sciences Social Studies Special Education State Policy, Rules & Procedures (Non-Content) Supervising Pre-Teaching/Pre-Service Student Technology and Design Visual Arts Vocational Agriscience and Natural Resources Vocational Education Vocational Health Sciences Vocational Human Sciences Vocational Human Services World Language World Language and Culture Writing

Narrative/Description *

Prerequisites or Restrictions (if applicable)

Would you like this displayed in the MDE SCECH catalog for anyone in the state to view? *
Yes
No

How do you plan to monitor and record attendance? *

What technology is required to participate in this program? *

How much are you charging participants to attend? *

How would you like to cover the SCECHs Processing Fee? *
- Select Option Charge our GVSU Department $200 to award SCECHs for up to 100 participants awarding SCECHs only no additional services EXTERNAL TO GVSU PARTNERS: Charge us $200 for up to 20 participants, plus $10 for each participant over 20.

Name of internal GVSU department to be charged: *

Mailing address and email address of the person/organization to be invoiced: *

Maximum Number of SCECHs Requested (rounded down to the quarter hour - Ex: 2 hours 50 minutes = 2.75 SCECHs) *

When do you plan to offer this program? (start date) MMM - DD - YYYY; 00:00AM/PM *
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2024 2025 2026 When do you plan to offer this program? (start date) MMM - DD - YYYY; 00:00AM/PM Hour - 1 2 3 4 5 6 7 8 9 10 11 12 When do you plan to offer this program? (start date) MMM - DD - YYYY; 00:00AM/PM Minute - 00 15 30 45 Is When do you plan to offer this program? (start date) MMM - DD - YYYY; 00:00AM/PM AM or PM - AM PM

When will this program end? MMM - DD - YYYY; 00:00AM/PM *
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2024 2025 2026 When will this program end? MMM - DD - YYYY; 00:00AM/PM Hour - 1 2 3 4 5 6 7 8 9 10 11 12 When will this program end? MMM - DD - YYYY; 00:00AM/PM Minute - 00 15 30 45 Is When will this program end? MMM - DD - YYYY; 00:00AM/PM AM or PM - AM PM

Please upload all INSTRUCTOR BIOGRAPHIES here. *
Please upload a file with the extension .csv, .xls, .doc, .pdf, .docx, .xlsx, .pub, .zip, .jpeg, .jpg, or .png with a maximum size of 1 MB (1024 KB)

Please upload all LEARNING OUTCOMES & OBJECTIVES here. *
Please upload a file with the extension .csv, .xls, .doc, .pdf, .docx, .xlsx, .pub, .zip, .jpeg, .jpg, or .png with a maximum size of 1 MB (1024 KB)

Please upload the FULL AGENDA here (must include content areas, start and end times for each area, and cannot include breaks or lunches/working lunches) *
Please upload a file with the extension .csv, .xls, .doc, .pdf, .docx, .xlsx, or .pub with a maximum size of 1 MB (1024 KB)

Program Contact Name *

Program Contact Phone Number *

Program Contact Email Address *

Program Website (or registration page) *