Substitute Professional Development Participation Form
for Distinguished Membership Points

We recognize that many organizations offer professional development opportunities to educators (both on campus and off). We want to commend you, and award you distinguished membership points, for your participation in such sessions. In order to receive credit for your involvement in outside events you must document the items found in the form below. Once you've attended the professional development session/workshop/conference please fill out this online form and also submit your proof of participation. Proof of participation my be a copy of any one of the following:
  • certificate of participation (dated and signed by head of event)
  • program of event (dated, with notes)
  • handwritten note from event coordinator (dated and signed)
  • feedback form filled out (shows your involvement at the time)
Turn in proof of participation to the KDP mailbox for processing by the Membership Chairperson. The mailbox is located on the lower left side of the mailroom (#1002 at entrance to school of ed across from Za's).
Or you can mail the necessary item(s) to:
Kappa Delta Pi
attn: Membership Chair
610 E. University
Room 1213 SEB
Ann Arbor, MI 48109
Be sure that proof of participation is clearly identifiable with your name, email, and member number to be matched with your online form.

KDP Member Information
1. Your Name:
        (first and last)
2. Your E-mail*:
        *must enter this field to successfully submit this form
3. Your Member #:
        (if known)

Event Information
4. Name of event:
5. Date of event:
6. Place of event:
7. Name of sponsoring organization:

8. Describe the reason for your attendance:

9. Describe your goal in participating:

10. Was your goal achieved? yes no
11. Why or why not?


12. Number of hours you spent at the event:
13. Describe the most beneficial aspect of the event:

14. Describe the least beneficial aspect of the event:


15. Would you attend a similar event in the future?
yes no
16. Why or why not?