Clark, Coles, Cumberland, Douglas, Edgar, Moultrie, & Shelby Counties

Provider Information

Professional Development Provider Forms

Approved Illinois Professional Development Providers (updated 10/05/2017)

Form 73-58 – Approved Professional Development Provider Activity Summary

Annual Approved Provider Report – This report must be submitted to the State Board of Education by June 30th annually in accordance with Section 25.860 Reporting by and Audits of Providers 23 Illinois Administrative Code.

Form 77-21A Evaluation for Workshop, Conference, Seminar, etc. – NEW! (Updated 9/17)

Form 77-21B Evidence of Completion for Professional Development – NEW! (Updated 9/17)

Notices of Professional Development—If you are interested in providing professional development and do not already have a Provider Number (you may check the ISBE Approved Provider List to make sure) you must contact the Regional Office Education with which you are affiliated. For Regional Office of Education #11 (Clark, Coles, Cumberland, Douglas, Edgar, Moultrie, or Shelby counties) please contact Katie O’Dell at or 217-348-0151.