PGP Certificate Request

Thank you for attending a session hosted by Keep Indiana Learning!

Please use the form below to evaluate the session and request a PGP Certificate. You will receive the certificate via email as a PDF file.

If you have any questions or need support, please reach out to us at keepindianalearning@ciesc.org.

NOTE: We are currently upgrading our PGP form process. There may be a delay in receiving your certificate. If you have not received your certificate by Monday, December 2, please reach out to keepindianalearning@ciesc.org.

Your Full Name(Required)

Please enter it as you would like it shown on your PGP Certificate.

First Last

Your Email Address to Receive the PGP Certificate(Required)

You will receive your PGP Certificate at this email address as a PDF attachment. If you do not receive your certificate, please check your SPAM email filter. Reach out to keepindianalearning@ciesc.org if you have trouble receiving your PGP certificate.

Name of School Corporation or Organization

Title of Session(Required)

As will appear on certificate. Please replace any colons : with a hyphen - to ensure the form submits correctly (if you are receiving an error after submitting).

Please enter the number of PGPs you earned for this session, course, or event.(Required)

Please enter a number from 1 to 100.

1hr = 1 PGP for live sessions Online Courses have a PGP value listed in the conclusion page of the course.

This field is hidden when viewing the form

Length of the Session

Presenter Name(s)

If known. Please separate multiple presenters with a comma.

What is the most important thing in this session that you learned or will share with others?(Required)

Date you attended/watched the session(Required)

I am satisfied with this delivery model/method (Live session, OnDemand, etc.).(Required)

Strongly Disagree

Disagree

Agree

Strongly Agree

How likely is it that something from today's session will impact your practice?(Required)

Not Likely At All

Not Likely

Likely

Very Likely

Please provide any additional comments or suggestions

Phone

This field is for validation purposes and should be left unchanged.