(copy information for each activity you are claiming)(each student relationship must be listed separately) Name of Mentor or Name of Executive Coaching Program: Leadership Personal Development Number of Number of – Start Date of Program (month and year): Hours: Hours g. Participating in an Executive Coaching Program or End Date of Program (month and year): Claimed: Formal Mentoring Program as a Mentee must be a formal Frequency of Meetings: program with a service contract with a qualified professional Length of Meetings: coach or a signed mentor/mentee agreement. Examples of Executive Coaching or Mentoring Activities: Maximum 15 hours per reporting period. (copy above information for each activity you are claiming)(each relationship must be listed separately) Total Hours Claimed for 2. Leadership: Mentoring, Teaching, and Facilitation (please add all points claimed in this section): 3. Participation Volunteer or Community Involvement (Section maximum: 70 hours) – Start Date (month and year): a. Board Service as Chair/Co-Chair Number of Number of End Date (month and year): Hours: Hours Sitting on a Board of Directors for a registered non-profit or Title: Claimed: charitable organization. Must be able to demonstrate Organization: responsibilities for meeting organizational objectives, Describe your role and responsibilities: completing project work and/or leading sub-committees. Maximum 20 hours per year per Board. (copy above information for each activity you are claiming) Start Date (month and year): b. Service as Board Member Number of Number of End Date (month and year): Hours: Hours Sitting on a Board of Directors for a registered non-profit or Title: Claimed: charitable organization. Must be able to demonstrate Organization: responsibilities for completing project work and/or leading Describe your role and responsibilities: sub-committees. Maximum 15 hours per year per Board. (copy above information for each activity you are claiming)(if more than one position, must list each individually) Start Date (month and year): Number of Number of c. Committee/Task Force Chair/Co-Chair – End Date (month and year): Hours: Hours For a registered non-profit or charitable organization. Must Title: Claimed: be able to demonstrate responsibilities for completing Organization: project work and/or leading sub-committees. Describe your role and responsibilities: Maximum 15 per year per committee.
(copy information for each activity you are claiming)(each student relationship must be listed separately) Leadership – Personal Development g. Participating in an Executive Coaching Program or Formal Mentoring Program as a Mentee must be a formal program with a service contract with a qualified professional coach or a signed mentor/mentee agreement. Maximum 15 hours per reporting period. Name of Mentor or Name of Executive Coaching Program: Start Date of Program (month and year): End Date of Program (month and year): Frequency of Meetings: Length of Meetings: Examples of Executive Coaching or Mentoring Activities: (copy above information for each activity you are claiming)(each relationship must be listed separately) Number of Hours: Number of Hours Claimed: Total Hours Claimed for 2. Leadership: Mentoring, Teaching, and Facilitation (please add all points claimed in this section): 3. Participation – Volunteer or Community Involvement (Section maximum: 70 hours) a. Board Service as Chair/Co-Chair Sitting on a Board of Directors for a registered non-profit or charitable organization. Must be able to demonstrate responsibilities for meeting organizational objectives, completing project work and/or leading sub-committees. Maximum 20 hours per year per Board. Start Date (month and year): End Date (month and year): Title: Organization: Describe your role and responsibilities: (copy above information for each activity you are claiming) Number of Hours: Number of Hours Claimed: b. Service as Board Member Sitting on a Board of Directors for a registered non-profit or charitable organization. Must be able to demonstrate responsibilities for completing project work and/or leading sub-committees. Maximum 15 hours per year per Board. Start Date (month and year): End Date (month and year): Title: Organization: Describe your role and responsibilities: (copy above information for each activity you are claiming)(if more than one position, must list each individually) Number of Hours: Number of Hours Claimed: c. Committee/Task Force – Chair/Co-Chair For a registered non-profit or charitable organization. Must be able to demonstrate responsibilities for completing project work and/or leading sub-committees. Maximum 15 per year per committee. Start Date (month and year): End Date (month and year): Title: Organization: Describe your role and responsibilities: Number of Hours: Number of Hours Claimed:
CPHR-PEI-CPD-Log.docx