Record of Professional Development

Please attach a copy of the conference program or agenda indicating which workshops/presentations you attended. Please return this to the Academic and Student Affairs office within 30 business days of your professional development.

Name (print):	Date:

Department/Division:

Status:	☐Faculty ☐Staff	☐Adjunct Faculty

Name of Conference/Meeting/Workshop:

Name of Sponsoring Group:

Location of Conference:

Date(s) of Conference:

Was this conference worth attending? ☐Yes	☐No

Would you recommend this conference to others? ☐Yes	☐No

Please complete the attached form for each workshop/presentation you attended and list*:

The name of the workshop/presentation

The name of the presenter

School/Organization of the presenter

A summary of the material presented

One idea you got from the presentation and how you plan to use it at Donnelly

*Please note that you may need to complete multiple pages of this form

Name of Workshop/Presentation:

Name of Presenter:

School or Organization of Presenter:

Summary of Presentation:

What you learned from the workshop/presentation:

How you plan to use this at Donnelly: