Official SealDepartment of Budget and Management

Supplemental Questionnaire

Last Name
First Name

Please indicate your American Sign Language skill level

Polite (able to greet and exchange pleasantries; indicate or understand an emergency)
Literate (understands a conversation and can respond)
Fluent (is your native language or can converse in the language as if it was your native language.)
Do not speak sign language.

Please check the position for which you would like to be considered

a. Early Childhood Education Dept. - Birth - 5 years
b. Elementary Department
C. Middle School
d. High School
e. Reading Specialist
f. Special Needs/Enhanced Services Programv
g. Technology Education (theatre, media, art)

Do you currently hold a Teacher Certification?  If so, from what state?


Have you previously obtained Highly Qualified status from a school district?

Yes No

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