May 10, 2004



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May 18, 2010

MEMORANDUM

To: Substitute Teachers

From: Brett Justice, Assistant Superintendent

Subject: Low-Incidence Substitute Work for the 2010-2011 School Year _________________________________________________________________

We are preparing our list of substitute teachers for the Scioto County Low-Incidence Units for the 2010-2011 school year and would like for you to fill out the questions below and return to this office.

1. Will you be available for substitute work this school year? ____ Yes ____ No

2. Designate the type of certificate/license you hold: ___ Provisional ___ Professional ___ Permanent

___ Long Term Substitute ___ Short Term Substitute

Date certificate/license expires: _____________________

3. Subjects or grades listed on certificate/license:

__________________________________________________________________________________

4. Designate which of the following programs you desire to do substitute work:

____ Preschool Handicapped ____Alternative/Progressive Education Program

(Bloom-Vernon, Minford, New Boston, Northwest, (Scudder Administrative Building – 411Court Street)

Valley, Washington-Nile, Manchester)

____ Severe Behavior Handicapped ____ Hearing Impaired

(Valley, Washington-Nile, Scudder Admin Bldg.,) (Green)

____ Multi-handicapped ____ Even Start

(Bloom-Vernon, Clay, Minford, Northwest, (Northwest – Union Bloom-Vernon, Scudder Adm. Bldg.)

Portsmouth East ES, Valley, Washington-Nile)

5. Are you a retired teacher? _____ Yes _____ No

An official college transcript, copy of Ohio teaching certificate/license, copy of tuberculosis test, and BCI & I and FBI background check are required to be on file at the South Central Ohio Educational Service Center

First Name: __________________________ MI: _____ Last Name: _______________________________

Address: ______________________________________________________________________________

_____________________________________________________________________________________

Phone Number(s): ____________________________________ Birth Date: ________________________

Date of Application: ____________________________ S. S. #: __________________________________

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411 Court Street • Room 105

Portsmouth, Ohio 45662

Phone: (740) 354-7761

Fax: (740) 353-1882

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