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Evidence of Completion for Workshop, Conference, Seminar, etc.. Form 77-21B - d131

Evidence of Completion for Workshop, Conference, Seminar, etc.. Form 77-21B - d131 2026

Evidence of Completion for Workshop, Conference, Seminar, etc.. Form 77-21B - d131 Preview on Page 1

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The document is a certificate renewal form from the Illinois State Board of Education, used to verify attendance at professional development activities such as workshops or conferences. It requires details about the event, including title, description, provider information, and participant signatures. Participants must retain this form for five years for potential audits.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the 'Title of Activity' at the top of the form. This should reflect the name of the workshop or seminar you attended.
In the 'Description/Nature of the Event' section, provide a brief overview of what the event entailed.
Fill in 'Training Was Provided By' with the name of the presenter or organization that conducted the training.
Enter the 'Date', 'Time', and 'Location' where the event took place, ensuring accuracy for record-keeping.
Indicate the 'Duration' in contact hours; remember that one CPDU is awarded per contact hour.
Print or type your name as an approved provider along with your provider number in the designated fields.
If applicable, specify the number of CEUs issued for this training session.
Both parties must sign where indicated to validate attendance and completion.
Optionally, complete a reflection statement to summarize your learning experience and its relevance to teaching students with disabilities.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (135 Votes)
2004	4.3 Satisfied (62 Votes)

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How to get PD hours in Illinois?

At the University of Illinois Urbana Champaign, educators can earn professional development hours by completing college coursework, participating in approved professional development activities hosted by University-affiliated personnel, working toward ISBE-approved microcredentials, and by working with University

How to become a Cila provider in Illinois?

Obtain a Community Integrated Living Arrangement (CILA) license issued by the Bureau of Accreditation, Licensure and Certification. Apply for a National Provider Identification Number (NPI) on the National Plan and Provider Enumeration System website. The NPI must be a Type 2 - Organizational NPI number.

How to become a PD provider in Illinois?

Newly Approved Professional Development Provider You must complete the registration form prior to offering any professional development activities. After registration is complete, your entity will appear in a dropdown menu of approved providers in ELIS and PD+.

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