CRITICAL NEED SCHOLARSHIP FOR TEACHERS



DELAWARE HIGHER EDUCATION OFFICE

2016–2017 ACADEMIC YEAR

CRITICAL NEED SCHOLARSHIP FOR TEACHERS

REIMBURSEMENT REQUEST (MUST BE COMPLETED IN ITS ENTIRETY)

Term: ( Fall 2016 X Spring 2017

School District or Charter School: _________________________________________________________

Teacher’s name: ______________________________________________________________________

Current subject area being taught: ________________________________________________________

College: ____________________________ Course number: _________ Credits: _____ Grade: _______

Course name: ________________________________________________________________________

( Undergraduate course ( Graduate course (Please check one)

Cost of course: $____________

Registration fee (if any): $____________

District contribution (if any): $____________

Final cost: $____________

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To be completed by School District or Charter School officials only:

Contact Name: Laura Palombo (302) 552-3725___________________________

Submitted By: Christine Smith Title: Director, Human Resources

Date: 6/09/2017 Phone #: (302) 552-3783 Email: chrstine.smith@redclay.k12.de.us

THE FOLLOWING INFORMATION MUST BE INCLUDED WHEN SUBMITTING THIS REQUEST:

□ Transcript or grade slip showing teacher’s name, course, and grade OR a computer printout of this information, as long as it is verified and signed off by a school district or charter school official.

□ College receipt showing the course and the cost of the course and registration fee (if any).

□ Valid evidence of Emergency Certification in a critical need area, to include one of the following:

o copy of teaching certificate,

o letter that was issued by the certification office,

o or a printout from DEEDS “District Center,” if it shows the subject area and effective and expiration dates

□ Upon request, an IV will be initiated via the FSF database.

□

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