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. #: __________________________________
-----------------------
411 Court Street • Room 105
Portsmouth, Ohio 45662
Phone: (740) 354-7761
Fax: (740) 353-1882
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