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Clock Hours

ONLINE CLOCK HOURS FORM

First Name

Last Name

Email

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Select Your Professional Learning

2022 SHAPE WA Fall Conference

Book Study

WELNET Focused Fitness Courses

P.E. Central

Other (Need Preapproval by SHAPE WA)

If you have not received your clock hour form within 72 hours, please check your inbox or spam/junk folder for a DocuSign email. Then ensure you accept all emails from DocuSign.

I understand

Did this course meet the objectives listed in the syllabus?

Yes

No

How would you rate the relevance and the quality of the offering?

Excellent

Above Average

Average

Not relevant to my teaching

The extent to which the activities identified in the program were met, where 5 is fully met and 1 is not met.

5

4

3

2

1

Comments on Objectives Met.

Comments on activities in the program being met.

Please list suggestions on improvement on the course.

Select One (Each Clock Hour Cost $2)

1 Clock Hour - $2

2 Clock Hours - $4

3 Clock Hours - $6

4 Clock Hours - $8

5 Clock Hours - $10

6 Clock Hours - $12

7 Clock Hours - $14

8 Clock Hours - $16

10 Clock Hours - $20

15 Clock Hours - $30

Other - $0

Select Book Study

Kristen Edmiaston (9 Clock Hours)

WELNET Courses. Select the Classes You Finished. Each Course is 1 Clock Hour.

Course #1

Course #2

Course #3

Course #4

Course $5

Course #6

2022 SHAPE WA Fall Conference (Highline High School)

Check the Box (Only 6 Clock Hours Max).

Did you receive approval from the SHAPE WA Executive Director? If yes, check box. If no, contact the Executive Director.

Course Name

Name of Instructor

Proof of Completion

Upload File

Upload supported file (Max 15MB)

Thank you for submitting your clock hours. We will be sending you the clock hour form via email soon. If you have any questions, please contact the Executive Director.

SHAPE WASHINGTON

Society of Health & Physical Educators - Washington State

executivedirector@shapewa.org

P.O. Box 1392

Port Angeles, WA 98362

Voice/Text: (360) 477-1852

©2023 SHAPE Washington

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