Application Form - PESB Clock Hour Provider

upLoading...

Redirecting you to a secure payment page…

HOME
{{profilePhoto.url?'':accountBasicInfo}}
- MY PROFILE
- Dashboard
- Log out

This is the account you will use to apply to be a clock hour provider in future years, so please note your log-in information and keep it in a safe place.

In the event that you cannot be reached, who else from your organization should we contact?

Include a submember in your membership registration

No payment is required to be a PESB Clock Hour Provider. Click "Submit" to submit your application for review.

PESB Clock Hour Provider - General

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Create an account to save your information and access our online portal

Password *

Retype Password

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

First Name *

Last Name *

Your Title *

Your Email Address *

Phone Number *

Provider/Organization Name *

Other names that your organization may be known as (acronyms, DBA, etc.) *

If none, please type "N/A"

Provider/Organization Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Country

Website

Is your organization a currently approved clock hour provider for 2025-26? *

Yes

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

First Name (additional contact)

Last Name (additional contact)

Job title (additional contact)

Email (additional contact)

Phone Number (additional contact)

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Why does your organization want to be a clock hour provider for the upcoming approval period? *

What is your organization’s experience and expertise in providing professional development to educators? *

Examples include experience offering clock hour courses, staff members' professional history, educational background in related fields, and any knowledge or experience that qualifies your organization to offer professional development to educators.

Names of All Clock Hour Committee Members *

Please list the full names of all clock hour committee members.

WAC 181-85-205 specifies records that must be kept by the clock hour providers. Describe how your organization will meet these requirements. *

Records include: documentation that the course, including the program agenda, was approved by the clock hour committee prior to being offered; a summary of the evaluations turned in by attendees; a committee meeting minutes; and more.

I am submitting this application on behalf of the organization named above. By submitting this application, I verify that all information provided is accurate to the best of my knowledge.

I certify with my typed signature below that the above-named organization will comply with ALL of the Continuing Education Program Approval Standards and required recordkeeping regulations specified in Professional Certification Continuing Education Requirement, WAC Chapter 181-85-205, and that written records for each program standard shall be maintained and be available for OSPI and/or PESB inspection for a period of seven (7) calendar years from the date of each inservice program offered. *

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Include a submember

{{subMemberDisplayName}} {{index+1}}: {{getSubMemberName(index)}}

Choose Existing Contact(s)

Membership Level *

I would like to automatically renew my membership

First Name *

Last Name *

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

Add {{subMemberDisplayName}}

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

{{orderSummary.membershipOrderItem.startDate}} - {{orderSummary.membershipOrderItem.endDate}}

{{orderSummary.membershipsTotal==0?'Free':formatAmount(orderSummary.membershipsTotal)}}

Membership auto-renews monthly for {{ formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipInstallment.cost) }} until {{ orderSummary.membershipOrderItem.membershipInstallment.endDate }}

Membership auto-renews on {{orderSummary.membershipOrderItem.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipAutoRenew.cost)}}

{{orderSummary.membershipOrderItem.cost==0?'Free':formatAmount(orderSummary.membershipOrderItem.cost)}} {{orderSummary.membershipOrderItem.termName}}

{{orderSummary.membershipOrderItem.startDate}} - {{orderSummary.membershipOrderItem.endDate}}

Membership auto-renews monthly for {{ formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipInstallment.cost) }} until {{ orderSummary.membershipOrderItem.membershipInstallment.endDate }}

Membership auto-renews on {{orderSummary.membershipOrderItem.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipAutoRenew.cost)}}

{{sm.userName}} ({{subMemberDisplayName}})

{{sm.startDate}} - {{sm.endDate}}

Membership auto-renews monthly for {{ formatAutoRenewAmount(sm.membershipInstallment.cost) }} until {{ sm.membershipInstallment.endDate }}

Membership auto-renews on {{sm.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(sm.membershipAutoRenew.cost)}}

Frequency selected: {{recurringUnitText}}. Next add-on payment processes on {{orderSummary.recurringDonationNextDate}} for {{formatAmount(orderSummary.donationAmount)}}

Discount Code

Code:

-{{formatAmount(orderSummary.codeDiscount)}}

Order summary

Subtotal {{formatAmount(orderSummary.subtotal)}}

Discounts -{{formatAmount(orderSummary.discounts)}}

Total {{formatAmount(orderSummary.total)}}

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Pay Later

I will mail in a check or money order

Please mail your payment to:
Old Capitol Building
600 Washington Street SE
Olympia, WA 98504-7236

Amount:

{{formatAmount(totalAmount)}} USD

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Membership level allows for a maximum of {{term.subMemberAllowed}} submembers.

	Contact Name	Membership Level
	{{item.contactName}}	{{item.membershipLevel==null?'-':item.membershipLevel}} {{item.startDate}} - {{item.endDate}}
No contacts.