Partnership Visit Form

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Effective January 1, 2019, per TCA 49-5-5631, all full-time faculty members, including academic deans or executive leaders, in a Tennessee approved EPP, who are involved in the preparation of teachers, shall further their professional development through DIRECT PERSONAL INVOLVEMENT in a public school or local education agency (LEA) on an annual basis.

Below, please document each instance of your direct personal involvement in a school, organization, or business.

Your first name *

Your last name *

Name of school/organization/business *

Date of visit

YYYY

If your visit is recurring, please indicate that here and indicate the date range below:

Recurring weekly

Recurring monthly

Other:

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Date range of recurring activity above

Total number of hours spent on this activity *

The primary purpose of the direct personal involvement was to *

Evaluate/observe of a candidate/student

Lead a professional development or workshop

Meet with a mentor or school administrator

Serve on a committee

Participate at school/community event (career day, Great Shake, guest reader)

Participate in a research and/or partnership activity

Collaborate on accreditation and/or strategic planning

Other:

Description of activity (optional)

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