Grand Rapids Community College

Name:

Department:

Phone Number:

Course Title:

Number of Hours Participated in Class:
(for example if the class met 2 hours a week for 10 weeks then the employee should have 20 hours of participation)

Start and End Date of College Course:

Professional Development Category:

Was this course part of your Leaning Plan?

Yes
No

*You must submit documentation showing successful completion of the course with a final grade and institution name (or certification or completion etc if not a graded course) by sending interoffice mail or emailing pdf's of the final grade to learningacademy@grcc.edu