Writing Assignment Module 6

ABC Child Development Center

Professional Development Plan

Employee Name: ________________________________________ Date: _____________

Child Care Facility: ______________________________________

Position: ____________________________________ Classroom: ___________________

Social Security #: _____________________(optional) # of children in classroom: _________

Educational Background:

		Yes (Year Completed)	No	In Process
High School Diploma	From:
GED	From:
Early Childhood Education (ECE) Coursework	Credential I Credential II Administration I Administration II Early Childhood Certificate Diploma
ECE Associate Degree	From:
ECE Bachelor Degree	From:
B-K Licensure	From:
A.A. or A.S. in another field	Major:___________________________ College: _________________________
B.A. or B.S. in another field	Major:___________________________ College: _________________________
Other training in last 12 months	CPR______ First Aid______ Other:
CDA Credential
Other/Specialty Certifications
Advanced Degrees

Long-Term Professional Development Goals:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Current Educational Activity:

Currently enrolled at (college/school): ______________________________________________

Are you currently enrolled in a degree program? YES NO

If YES, Degree/credential program _________________________________________________

Classes you are enrolled in at present time ___________________________________________

Classes you have already completed to date __________________________________________

# Semester credit hours you completed during last 12 months ____________________________

# Classes or # credits completed to date ____________________________________________

Expected degree completion date _________________________

Current Financial Aid: ______ Pell Grant ______ T.E.A.C.H.

______ Other (Please specify) ____________________________

If not enrolled in T.E.A. C.H., why not? _____________________________________________

Are you currently enrolled in WAGE$ YES NO

If not enrolled in WAGE$, why not? ________________________________________________

Short-Term Professional Development Goals:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Goals for Next 12 Months:

Action Steps	Timeline	Progress Toward Goal
1.
2.
3.

Employee Signature: _____________________________________ Date: _____________

Supervisor Signature:_____________________________________ Date: _____________