Application for Participation in Arkansas Paraprofessional ...
ADE-SEU Special Education Tuition Reimbursement Program Application
|Completed Application must be received by January 12, 2005. Return by mail or fax to: |
|Susie Branon, Special Education Unit, Arkansas Department of Education, Victory Building, 1401 West Capitol, Suite 450, Little |
|Rock, AR 72201 |
|FAX: 501-682-4248 |
Name ___________________________________Social Security#_________________
Mailing Address __________________________________________________________
__________________________________________________________
Email Address _________________________________________________________
Phone (Work) ________________________ (Home) _________________________
Arkansas Resident _________Yes ___________No
(Optional) Sex: _________Male __________Female
(Optional) ___Black, Non-Hispanic ___ White, Non-Hispanic ___Hispanic
___American Indian or Alaskan Native ___Asian or Pacific Islander ___Unknown
Name of Institution to be attended in 2005_________________________________
Applicant agrees to acquire a license in Special Education. ____Yes
Classification of applicant as of Fall 2004 (Check one):
___Teacher currently working in a public school willing to get on an Additional Licensure Plan (ALP) for special education licensure (______________________School)
___Teacher currently working in a public school working under a current ALP for special education licensure; 1st__, 2nd __ year on ALP (check)
___Enrolled in college program for special education licensure but not employed currently in a public school teaching position. ____ hrs. completed in special ed program
Commitment Statement:
My signature below indicates my agreement to work in an Arkansas public school needing fully licensed special education teachers for one year for each year of stipend received at the completion of this signed program.
_______________________________________________ ___________________________
(Signature of Applicant) (Date)
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- government participation in business
- government participation in the economy
- participation in government class
- participation in government test
- women participation in government
- public participation in government
- popular participation in government
- application for enrollment in medicare
- participation in government worksheets
- application for scholarship in qatar university
- participation in government class worksheets
- application for fingerprints in pa