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Marshall Teacher Residency-Summit Public Schools

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

Ethnicity (optional)

Gender Identity (optional)

Do you have a Bachelor's Degree?

Name of College/University

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

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

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

Your Signature

Select the course you completed:

Completed FULL Program - 31 PDUs (2021-22 and AFTER) - $1550

Completed FULL Program - 32 PDUs (2020-21 and BEFORE) - $1600

SUMMER 6071-A Marshall Teacher Residency: Curriculum, Instruction, and Assessment (Part A) - 2 PDUs - $100

SUMMER 6073-A Marshall Teacher Residency: Diversity and Access (Part A) - 2 PDUs - $100

SUMMER 6074-A Marshall Teacher Residency: Professional Growth (Part A) - 2 PDUs - $100

FALL 6071-B Marshall Teacher Residency: Curriculum, Instruction, and Assessment (Part B) - 6 PDUs - $300

FALL 6072-B Marshall Teacher Residency: Culture of Learning (Part B) - 1 PDU - $50

FALL 6073-B Marshall Teacher Residency: Diversity and Access (Part B) - 3 PDUs - $150

FALL 6074-B Marshall Teacher Residency: Professional Growth (Part B) - 3 PDUs - $150

SPRING 6071-C Marshall Teacher Residency: Curriculum, Instruction, and Assessment (Part C) - 6 PDUs - $300

SPRING 6072-C Marshall Teacher Residency: Culture of Learning (Part C) - 1 PDU - $50

SPRING 6073-C Marshall Teacher Residency: Diversity and Access (Part C) - 2 PDUs - $100

SPRING 6074-C Marshall Teacher Residency: Professional Growth (Part C) - 3 PDUs - $150

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