Lammersville Unified School District

PDU REQUEST FORM

Admissions Notes

Full First & Last Name

Phone

Previous Name(s) if any:

Last 4 digits (SSN)

Date of Birth

Home Address

Mailing Address

Name of College/University

Upload File

I understand that I need to check with my employer to ensure they will accept PDUs.

I certify that the information given in this request form is complete and accurate.

I understand that an official transcript is not included with this purchase.

Your Signature

Select the PD you completed:

6094 LUSD: Beyond Blended Learning Academy 2022-2023 (3 PDUs) - $225

6095 LUSD: Teacher Reading Academy 2021-2022 (4 PDUs) - $300

7026 LUSD: Data Driven Instruction (3 PDUs) - $225.00

8014a LUSD: Makerspace 101 (3 PDUs) - $225.00

8029 LUSD: Makerspace for Mastery (3 PDUs) - $225.00