Skip to form
CodeVA Professional Learning Request
First name
*
Last name
*
Email
*
School, District or Organization
*
Your Role
Please Select
Central Office or Division Level Leader
Core Classroom Teacher
Counselor
Data or Academic Coordinator
Director, Supervisor, or Department Chair (Building Level)
Instructional Coach (Building Level)
Instructional Lead or Specialist (Building Level)
Instructional Technology (ITRT, ILC, or similar role)
Interventionist (Title I or non-Title I positions)
Librarian or Media Specialist
Pre-service teacher
Resource or Elective Teacher
School Administrator
Special Education Teacher
Substitute
Support Staff (Paraprofessional, Instructional Aide, Psychologist, etc.)
Technology Support (TST/IT)
Other
General topic area
*
What topic(s) would you like covered?
Tentative Date(s)/Time of Year
*
When would you like to schedule the PD? (Provide specific dates or a general timeframe.)
Anticipated Number of Attendees/Participants
*
Preferred PD Modality
*
Please Select
In-person
Virtual
Hybrid
PD Format & Duration (Select all that apply)
*
Conference-style presentation(s) (1 or more 30-90min presentations)
Full-day PD session (one 3-6hr session)
Multi-day contiguous sessions (2 or more full-day sessions over the course of several days in a row)
Multi-day non-contiguous sessions (2 or more full day sessions over the course of several weeks, with “off-days” in between sessions)
Asynchronous course (self-paced or self-guided online modules—virtual only)
Other (provide details in the information section below)
Any additional information you would like to provide
Submit