ILLINOIS STATE BOARD OF EDUCATION

Educator and School Development

100 North First Street

Springfield, Illinois 62777-0001

EVIDENCE OF COMPLETION FOR WORKSHOP. CONFERENCE, SEMINAR. ETC.

EVIDENCEOF PARTICIPATION: This is to certify that the undersigned has attended the training program described below. DIRECTIONS: This form serves as evidence of completion to verifyattendance at a conference, workshop, or other professional devel opment training activity. Providers must complete the information identified below. Certificate holders must keep this form for a period

offive years and produce itifrequested to do so for a random audit. Both parties must sign the fonn where indicated.
Ready Set Move: Critical for Brain Development for All Children
DESCRIPTION/NATURE OF THE EVENT

TITLE OF ACTIVITY

This training includes appropriate modifications of activities for the children with special needs. Learn strategies you can pass along to encourage parents to experience and enjoy the fun of physical activities with their children.
APPROVED PROVIDER AND PROVIDER NUMBER

Illinois STARNET #100107

LOCATION (Name of Facility, City and State)

Westside Technical Institute, 2800 8. Western Avenue, Chicago, IL 60608

DURATION (Contact Hours) ONE CPDU PER CONTACT HOUR 3 hours
NAME OF PRESENTER

START DATE

START TIME

END DATE

END TIME

3/21/14

12::30 pm

3/21/14

3:30 pm

SIGNATURE OF PROVIDES^ REPRESE:ntati^

Marilyn Peterson

Information supplied in the box below is optional and is completed by the participant/certificate holder if desired.
REFLECTION STATEMENT: (OPTIONAL) Although the Reflection Statement is no longer required, you may want to use this space to summarize this activity and what you learned. You may also want to indicate Ifthis activity meets Purpose E (least restrictive environ ment requirement) and how it applies to teaching students with disabilities in the least restrictive environment.

Print or Type Name of Participant

Signature of Participant

Date

(TOBE RETAINED BYTEACHER FORS YEARS AFTS^ RENEWAL OF CERTIFICATE)

ISBE 77-21B (9/09)

< V
ILLINOIS

STARnet
Support and Tcdodcal Aatlstaoce KegkxaQy

Chicago Public Schools Office ofSpecial Education <S Supports 125 S. Clark, Chicago, IL 60603

Certificate ofAttendance
Awarded to:

Com
License Adfim:

Ready Set Move: Criticalfor Brain Developmentfor All Children (PM)

Ahealthy lifestyle begins early in life. Young children who are inactive risk becoming overweight. In this fun and active workshop, we will explore ways to intentionally plan organized movement skills that help
children build motor skills, learn about physical fitness, and lay the groundwork for habits that will last a

lifetime. This training includes appropriate modifications of activities for the children with special needs.
Learn strategies you can pass along to encourage parents to experience and enjoy the fun of physical activities
Presenter: Marilyn Peterson
March 21, 2014

with their children.

Arfuro Velasquez Institute

2800 S. Western, Chicago, IL 60608

12:30 pm - 3:30 pm
(3) Contact/Clock Hours

Continuing Professional Development Units

(CPDU)
Teacher Recertification
ISBE #100107

Continuing Education (CE) Continuing Education (CE) Continuing Education (CE)

Speech Pathology/Audiology
Social Work

IDPR #202-000101
IDPR #159-000238 IDPR #216-000046 IDPR # 224-000036

Continuing Education (CE)

Child Development Associate (CDA)
GatewaysTraining EventID

Physical Therapy

Occupational Therapy
competencies

Content Area 2: To advance physical and intellectual