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You MUST sign in at
booth 1127 to be eligible
for WA State clock hours!

Clock Hour Form

First Name

Last Name

Email

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Course Title

Course Instructor

Did the course meet the objectives listed in the syllabus?

Select an option

Yes

No

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

Select an option

5

4

3

2

1

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

Select an option

Excellent

Above average

Average

Not relevant to my teaching

Comments on objectives met.

Comments on activities in the program being met.

Please list suggestions for improvement on the course.

Select one:

PE Central

Welnet/Focused Fitness

SHAPE WA Fall State Conference

SHAPE WA West Best

SHAPE WA East Best

SHAPE America National Convention

Other

Select one:

1 clock hour - $2

2 clock hours - $4

3 clock hours - $6

4 clock hours - $8

5 clock hours - $10

9 clock hours- National Convention - $18

12 clock hours- National Convention - $24

15 clock hours - $30

18 clock hours- National Convention - $36

21 clock hours- National Convention - $42

25 clock hours - $50

27 clock hours- National Convention - $54

30 clock hours- National Convention - $60

36 clock hours- National Convention - $72

39 clock hours- National Convention - $78

45 clock hours- National Convention - $90

48 clock hours- National Convention - $96

Thank you for submitting your clock hours. We will be sending you the docu-sign OSPI 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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