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. 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.HiddenLength of the Session0 - 30 Minutes31 - 60 Minutes1 - 1.5 Hours1.5 - 2 Hours2 - 2.5 Hours2.5 - 3 Hours (Half Day)3 - 3.5 Hours3.5 - 4 Hours4 - 4.5 Hours4.5 - 5 Hours5 - 5.5 Hours5.5 - 6 Hours (Full Day)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)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920I 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 suggestionsCommentsThis field is for validation purposes and should be left unchanged.
