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#21-009009-0024
Supplemental Questionnaire

Last Name
First Name

 

***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.***
1

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.
2

Please check the position for which you would like to be considered
Early Childhood Education Dept. - Birth - 5 years
Elementary Department
Middle School
High School
Reading Specialist
Special Needs/Enhanced Services Program
Technology Education (theatre, media, art)
3

Do you currently hold a Teacher Certification?  If so, from what state?
4

Have you previously obtained Highly Qualified status from a school district?
Yes No

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