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 Group
If individual, state Job Title: ___________________________________________________________
Professional Development Activity
Sponsor
Name: ______________________________________________________________________
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Activity
Title: ________________________________________________________________________
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Activity
Location: ____________________________________________________________________
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Target Audience: ____________________________________________________________________
____________________________________________________________________________________
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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: _________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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PDUs Assigned: __________
Approval Signature: ___________________________________ Date:
_____ / _____ / _______
(To be completed by the Office of Certification)
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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.
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