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					                                                                                                 Attachment B, Memo No. 205-12
                                                                                                                August 17, 2012

                 APPLICATION FOR 2012-2013 CTE CURRICULUM DEVELOPMENT


As explained in Superintendent’s Memorandum No. 205-12, the Office of Career and Technical Education is seeking
nominations for the 2012-2013 CTE curriculum development and revision writing teams. School divisions are asked to
nominate one or more representatives for each committee. The schedule for the committees is attached.

Completed applications are due by September 17, 2012, to the Office of Career and Technical Education Services, Virginia
Department of Education, at CTE@doe.virginia.gov or Fax, 804-530-4560. If you have questions, call 804-225-2052.


Name: Click here to enter text.                               Title: Click here to enter text.

School Division: Click here to enter text.                   School: Click here to enter text.

School E-mail Address: Click here to enter text.             Alternate E-mail: Click here to enter text.

Home and/or Cell Phone: Click here to enter text.

Name of CTE Curriculum Development Team you are applying to serve from attached list. (Note: You may list a first and
second choice, but a teacher will serve only on one (1) development team):

First Choice: Click here to enter text.
Second Choice (if applicable): Click here to enter text.

Number of Years of Teaching Experience in the CTE content area applying (minimum 3 years required): Click here to enter
text.

Industry credential(s) obtained in area applying (as applicable): Click here to enter text.

CTE Courses You Currently Teach: Click here to enter text.

Other CTE Courses You Have Taught: Click here to enter text.

Experience in working with students with special needs and differentiated instruction: Click here to enter text.

Do you hold a current, valid Virginia Teaching License: Yes            No
If yes, what is the teaching area listed on the license: Click here to enter text.
List any other endorsements noted on the license: Click here to enter text.

Ability to Use:
Google Docs:             Proficient     Somewhat Familiar             Never used
*SSWS Drop Box:          Proficient     Somewhat Familiar             Never used
*Single Sign-on for Web Systems (SSWS)—contact your local information technology specialist for more information.


Approval of applicant’s school principal (please sign) _______________________________________________________

Thank you for your application.

				
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