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

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

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

Address *

City *

Zip Code *

Category (select most applicable option) *
- Select Option Assessment Behavior/Classroom Management Business Education Career and Technical Education Child Development Communication Skills Computer Science Curriculum Development District Provided Professional Development Diversity, Equity, and Inclusion Education Policy and Law Educational Technology English as a Second Language/Bilingual English Language Arts Gifted and Talented Health/Physical Education Instructional Practices/Pedagogy Leadership Skills Library/Media Literacy Mathematics Mentoring and Supervising Music Education National Board Certification Parent/Community Relations Professional Learning Communities School Administration School Counseling School Safety School/District Continuous Improvement Sciences/Environmental Studies Social Emotional Learning/Mental Health Social Sciences Social Studies Special Education Visual and Performing Arts Education Welcome Back Proud Michigan Educators Campaign World Languages

Narrative/Description *

Prerequisites or Restrictions (if applicable)

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? *

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

Program Descriptors (select most applicable option) *
- Select Option Early Childhood Elementary High School Middle Grades Multiple Age/Grade Levels Other

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: *

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 - 2025 2026 2027 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 - 2025 2026 2027 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) *