DeKalb County School System-Georgia State University MathScience by bmd18385

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									      Please be advised that the Math Science Transition to Teaching Program includes a student teaching practicum. This
      practicum will require participants to request a professional leave of absence without pay for approximately 12 weeks
      near the end of their program of study.


              DeKalb County School System-Georgia State University

                      Math/Science Transition to Teaching Program
Last Name:___________________________First Name:______________________________________

Street Address:_________________________________________________________________________

City:______________________________________Zip:_________________________________________

Phone Number: Home:_______________________Work:__________________Cell:________________

Email Address Home:________________________Work:_______________________________________

DCSS I.D. Number:________________________State Certification Number:_____________________

Para Professional (Y):__Name of Supervisor :____________________School :____________________

Classified Employee (Y)__Position __________________Name of Supervisor:____________________

Name of
College:_______________________________________________________________________________

Associates Degree (Y)___(N)___60 Semester Hours or 90 Quarter Hours:____________

                                         DeKalb County School System

                                     Department of Professional Learning

                                        Attention: Mrs. Katherine LeDuke

                                                Phone: 678-676-0388

								
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