M.S.A.D.49 Teacher Certification (SSSC)

Professional Renewal Plan (PRP)

Name: ________________________         SS #: _______________________

Building ______________________         Date of Certificate's
                                                                  Expiration: __________________

Grade Level/Subject_______________    Date Received: _______________

Activities involved to acquire equivalent of 6 credits or 90 contact hours or 9 ceu's

Time Table:

Signature : ________________________________

SSSC Approve: ________________________________

SSSC Deny: ________________________________

Certificates of coursework and/or portfolio of work completed need to be submitted before final approval. This application must be typed. Continue on back if necessary.