TSBVI Outreach has applied to the ACVREP for CEU credit on the all of our TETN broadcasts. Pending approval we will award 1 ¾ hours credit for individuals watching this TETN after the original broadcast date.

Anyone seeking Academy credits (COMS, LVT, VRT) should:

1. Complete the ACVREP Evaluation.
2. Complete the ACVREP Proof of Attendance form and have it signed by an ESC Consultant or Local Administrator that can verify their attendance.
3. Send both of these forms to Kate Moss at TSBVI via fax at 512-206-9320 and maintain a copy for your records.

Upon receipt of these documents and approval from the Academy an ACVREP Certificate will be emailed to the individual. No certificates will be mailed, so make sure you have the correct email address.

DO NOT COMPLETE THIS PAPERWORK IF YOU ARE NOT A COMS, LVT OR VRT. The SBEC CPE evaluation and certificate is all that is needed for TVI, special or general education teachers or paraprofessionals.

ACVREP EVALUATION FORM

Name:

Title:

Email address (please print clearly):

Phone:

ACVREP approved CE program/activity: (Title and Broadcast #)

Program/activity date(s):

Please answer the following questions, indicating your level of satisfaction by circling the appropriate number:

1. The content of the presentation met my expectations:

Extremely Satisfied (1)

Satisfied ( 2)

Neutral (3)

Dissatisfied (4)

Extremely Dissatisfied (5)

2. The presenter(s) provided valuable information that will help me in my profession:

Extremely Satisfied (1)

Satisfied ( 2)

Neutral (3)

Dissatisfied (4)

Extremely Dissatisfied (5)

3. The presenter(s) were knowledgeable and helpful:

Extremely Satisfied (1)

Satisfied ( 2)

Neutral (3)

Dissatisfied (4)

Extremely Dissatisfied (5)

4. Will your job performance or advocacy efforts change in any way as a result of this program?

_____ Yes _____ No _____ Undecided

5. I would recommend this training to my peers/colleagues in the vision rehabilitation and education field:

_____ Yes _____ No _____ Undecided

What information from this TETN broadcast are you most likely to use in your current position?

Comments (please use the back of this sheet if necessary):

Return your completed evaluation sheet to your ESC TVI Consultant . ACVREP evaluations should be fax to Kate Moss at TSBVI Outreach (512-206-9320) with a copy of the ACVREP Proof of Attendance form for this broadcast. Once attendance has been verified and matched to an evaluation form, a ACVREP certificate will be emailed to the participant. You must include a valid email on this evaluation form and ACVREP Proof of Attendance form if you wish to receive a certificate. NO CERTIFICATES WILL BE MAILED. Thanks!

TETN ACVREP Certificate Request Form

I would like to receive an ACVREP certificate for 1 ¾ hours of training for TETN Broadcast #

Name and broadcast # of the TETN

I have viewed the tape, completed the evaluation form and am faxing it along with this signed form to:

Kate Moss at 512-206-9320

Name:

Email address (please PRINT clearly in BLACK INK):

ESC Region:

Viewing date: Viewing location:

I am verifying that the above named individual has watch the TETN broadcast listed on a date other than the original broadcast date and should received an ACVREP certificate.

Signature of Supervisor or ESC Representative

Date: