AAFCS PDU Pre-Approval Application
Please type all information within the indicated margins. If you have questions, please refer to the application instructions here. Documentation showing a specific time breakdown and the content of each professional session is required with PDU Pre-Approved Applications. If any section of the application is incomplete, the application will automatically be denied. Complete this form and return to: AAFCS Office of Certification, 400 N. Columbus Street, Suite 202, Alexandria, VA 22314 Phone: 703-706-4600 Fax: 703-706-4663

Name: (Last, First, Initial) _______________________________________________________
Home Address:
_________________________________________        Phone:
_________________________________________        Daytime: _______________________
_________________________________________              Fax: _______________________

Email Address: ___________________________

Activity Beginning Date: _____ / _____ / ________    Number of PDUs Requested: __________
Activity Ending Date: _____ / _____ / ________

Application For:   Individual Individual    Group Group
If individual, state Job Title: ___________________________________________________________

Professional Development Activity

Sponsor Name: ______________________________________________________________________

Activity Title: ________________________________________________________________________

Activity Location: ____________________________________________________________________

Target Audience: ____________________________________________________________________
____________________________________________________________________________________

Objectives: _________________________________________________________________________
____________________________________________________________________________________
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Description: (Limit to only 25 words) _____________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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Relationship: (Explain relationship of this activity to professional development.) __________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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Presenters: _________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

 

 

PDUs Assigned: __________ 
Approval Signature: ___________________________________  Date: _____ / _____ / _______
(To be completed by the Office of Certification)

 

Office of Certification
American Association of Family and Consumer Sciences, 400 N. Columbus Street, Suite 202, Alexandria, VA 22314

Please retain a copy of this application for your records.