Instructions for Completing the
Bilingual/ESL Stipend Verification Forms
1. Fill in the Blanks
a. Name of Teacher - Indicate any teacher name changes by writing previous or new
b. Grade - Write in applicable grades.
(1) For a teacher who is assigned to any ESL or bilingual class after the first day in
the assignment. This includes teachers who have transferred from another HISD
school. For all others, the assignment block will remain blank.
(2) For the teacher who transfers, leaves the district or changes assignment prior to
the end of the current school year, list the last day of assignment at the current
d. Medical Leave - First and last day of medical leave is listed. Please make revisions
(1) Bilingual Self-Contained Teacher Form - This form is to be used for elementary
and middle school bilingual self-contained teachers, including Dual Language
teachers. Indicate number of LEP students in grades PK-6 receiving Spanish
Reading/Spanish Language Arts or number of LEP students in pre exit phase
receiving Spanish support in grades 4-6. In PK, indicate number of LEP children
taught in AM and PM classes. If bilingual program is Vietnamese, indicate this
on the form. If bilingual teacher is in a Two-Way Dual Language, indicate this on
(2) ESL Self-Contained Teacher Form - This form is to be used for elementary and
middle school self-contained ESL teachers. Indicate the number of LEP students
by ESL level making sure to separate number of Spanish speaking students from
speakers of other languages besides English. In PK indicate number of LEP
students taught in AM and PM classes.
(3) Secondary ESL Teacher Form - This form is to be used for secondary ESL
teachers. Indicate the name of the state mandated ESL course per period, per
teacher. Then indicate the number of LEP students by ESL level, per period of
instruction. Be sure to include all ESL courses in a 9-week accelerated block, an
18-week every-other-day block or regular/conventional schedule for the
(4) Secondary Bilingual Content Teacher Form - This form is to be used for eligible
bilingual content area teachers in secondary schools. Indicate by teacher and
class period the name of the bilingual core-content area course (math, science,
social studies) being taught in the native language (i.e. Spanish, etc.) Spanish or
other native language must be used for instruction not just for clarification and
directions. Then indicate the number of LEP students per period of instruction.
Be sure to include the classes in a 9-week accelerated block, and 18-week
every-other-day block or regular/conventional schedule for the semester.
(5) Bilingual/Special Education Teacher Form - This form is to be used for teachers
who provide both Bilingual and Special Education services. Please indicate the
number of LEP students served each day if the student is served in a self-
contained program. Schools must include a LEP student roster indicating code
of LEP student served in bilingual program (Y-B, Y-T, or Y-D). Schools must
also provide a copy of the teacher's daily schedule describing service to LEP
students (i.e., Spanish language arts) for each teacher listed on stipend
(6) ESL Special Education Teacher Form - This form is to be used for teachers who
provide the state required ESL language arts program in a Special Education
setting. Please indicate the number of LEP students served each day if the
student is served in a self-contained program. If the services are provided
incrementally please attach an explanation of services and include the number of
students at each time allocation interval. Schools must include a LEP student
roster indicating code of LEP student served in ESL program (Y-E). Schools
must also provide a copy of teacher's daily schedule describing service to LEP
students (i.e., ESL language arts and/or reading) for each teacher listed on
stipend verification form.
f. Verification - The principal and the bilingual instructional supervisor will verify
eligibility. The principal must verify by checking () if the teacher is providing ESL
instruction and using the ESL state-adopted system for ESL classes or () if the
teacher is using Spanish or Vietnamese as the language of instruction in bilingual
classes as required. The bilingual instructional supervisor will verify by initialing if the
teacher is providing appropriate instruction for ESL or bilingual classes.
2. Delete Information
Delete any teacher on your printout list who is no longer in a Bilingual or ESL
assignment by drawing a heavy red line through the name. This includes any
teachers who have transferred to other HISD schools or who have left the district.
Indicate the last day the teacher was in the assignment at your school.
3. Correct Information
Draw a red line through any incorrect information and print the correct information above
the line. Please indicate whether the teacher has a name change by writing the previous
or new last name on the form. This is very important to assure that the teacher receives
4. Add Information
All new teachers or teachers currently at your school who are in a bilingual or ESL
assignment and are not listed must be reported by adding all required information at the
bottom of the printout or on the blank form. (Please note that if a name does not
appear on the stipend verification form, there may be a job code problem.)
The principal must report to the Human Resources Generalist or Budget Analyst any change
(deletes, corrections or adds) to the teacher’s job code.
Please check to assure forms are completed accurately. Any incomplete (no grade levels,
missing signatures, etc.) will be returned and will not be processed for the June 8, 2011
payment. Verification of native language instruction in Spanish or Vietnamese and ESL
instruction must be verified by the principal and the bilingual instructional supervisor at various
times during the school year to ensure appropriate delivery of instruction.
Remember that each teacher who does not receive the stipend on June 8, 2011 and who is
inquiring why she/he did not receive it must submit a Stipend Questionnaire form. Stipend
Questionnaires can be downloaded and/or printed from the Multilingual Department intranet
website. The teacher and the principal must sign this form. No action will be taken unless a
form has been submitted.