Activity Type:
Inservice	Continuity
A Taste of OWP (A three hour on-site inservice program)	Advanced/Open Institute
OWP Inservice Series (A ten hour on-site inservice program)	University Course
Statewide In-service Day Program	Follow-up/Retreat/Renewal
Demonstration Lesson/Coaching	Site Governance/program planning
Site-sponsored conference/conference session	A Taste of OWP (A three hour on-site inservice program)
School/district writing assessment/exam. student work	Support session (coaching, planning, debriefing)
Workshop Series	Workshop or workshop series
Study/Discussion/Research Group	Writing groups/publication efforts
Collaborative planning/curr. Development	Other:
Other:

Event Date(s):

Event Time(s):

Event Location:

For Teachers of Grades (please check all that apply):
Pre-K	2	5	8	11
K	3	6	9	12
1	4	7	10	Post Secondary

Facilitators/Presenters:

Description of/Agenda for the Event (please add additional pages if necessary):

Primary Goal of the Event:

Types of Activity Included in the Event (please check all that apply):
Lecture or Presentation*
Demonstration Lesson*
Development of Curricular Units/Lesson Plans*
Guided Instruction in the Use of a Pre-Developed Curricular Unit
Analysis of a Real or Hypothetical Teaching Situation
Review of Student Work*
Doing the Discipline
Group Discussion or Group Work
In-Depth Reading on a Specific Topic
Preparation of a Paper, Report, or Research Project
Coaching or Mentoring
Leadership Development*
Writing activity*
Technology for teaching
Other:

Leadership Roles:
Percentage of Event Led by Site Director(s):	%
Percentage of Event Led by Teacher-Leaders:	%
Percentage of Event Led by Others:	%
Participant Information:
# of OWPWU teacher consultants:
# of other teachers:
# of administrators:
# of students:
# of others:
Schools Represented:

Budget:
Cost per participant:	Total Income:
Stipend for leaders:
Travel:	Total expenses:
Supplies:
Other:
In kind contributions:

Participant Feedback collected (surveys, feedback forms, etc)::

Successes and suggestion:

Prepared by:		Date:
Phone:	Email: