Docstoc

Legal Aide for Bentonville Arkansas

Document Sample
Legal Aide for Bentonville Arkansas Powered By Docstoc
					                              Non-Traditional Licensure Program Application
TeachArkansas will assist with, or actively pursue, job leads in Arkansas schools for each candidate enrolled in the NTLP, unless notified otherwise.
Each school district contacted through TeachArkansas is an Equal Opportunity Employer. Applicants receive equal consideration without regard to
race, religion, color, national origin, gender, sexual orientation, political affiliation, age, disability, or any other non-merit factor. Qualified applicants
with disabilities may request reasonable accommodations to participate in the application process.
                                                             Fields with an asterisk (*) are optional.
                                                          Personal Information
Name: (Last)                                   (First)                            (MI)         (Maiden)

Check One: First Year NTL Applicant ______               OR        Second Year NTL Applicant _______


Candidate ID #: (DOB and Last 4 SSN: mmddyyxxxx)____________________________________________
Gender:* F □ M □
Date of Birth: _____/______/_____
Ethnicity:*     □ Native American (Indian, Eskimo, Aleut)       □ Asian / Pacific Islander □ Black / African American
                □ Latino / Hispanic                             □ White /Caucasian         □ Other: __________________
Current Mailing Address:

City:                                                     State:                     Zip:                  County:

Current/ Valid E-Mail Address:

Primary Telephone:                                                   Alternate Telephone:
Permanent Address (If different from Current Address ):


City:                                                     State:                    Zip:                   County:
Where in Arkansas would you prefer to teach?
Central □               Northeast □          Northwest □                        Southeast □            Southwest □          Any □
First preference for NTLP Instructional Module site:
Bentonville □      Helena □      Hot Springs □       Jonesboro □          Little Rock □     Monticello □      Van Buren □   Hope □
Second preference for NTLP Instructional Module site:
Bentonville □      Helena □      Hot Springs □       Jonesboro □          Little Rock □     Monticello □      Van Buren □   Hope □
Which of the following best describes your most recent experience? (Please choose one.)
□Advertising/Marketing/PR           □Government                          □Non-Profit & Social Services
□Agriculture                        □Healthcare/Health Services          □Paraprofessional/Instructional Aide
□Consulting Services                □Information Technology              □Retail/Wholesale
□Engineering                        □Law                                 □Student
□Financial Services                 □Law Enforcement                     □Telecommunications/Media
□Firefighter                        □Military                            □Other (Specify)

If you checked Military, would you be interested in the Troops to Teachers Financial Bonus Program?          □ Yes □ No

                                                              Legal Information
Have you ever been convicted of a crime?      □ Yes      □ No If “Yes”, please explain.

Have you ever been dismissed, asked to resign, or resigned in lieu of termination from any position?   □ Yes         □ No
If “Yes”, please explain.

Are you a U.S. citizen or a lawful permanent resident of the U.S.?     □ Yes □ No If “No”, please explain.

Have you been discharged from the military services under other than honorable conditions?     □ Yes □ No
If “Yes”, please explain.

Have you ever had a teaching license revoked, suspended or place on probation by a state education agency or other administrative agency or
court of law? □ Yes □ No If “Yes”, please explain.
                                                                      Education
                                (Please include all colleges/universities and/or trade schools from which you have a degree.)
                                                                                              Date of Major(s)
                                                                                              Degree & Type Minor(s)                      GPA
           Undergraduate / Graduate/Doctorate Institution              City, State, & Country (Received
                                                                                                 or
                                                                                                          of                           (4.0 Scale)
                                                                                              Expected) Degree




                                                   Praxis I: Basic Skills (PPST) Scores

               Praxis I: Basic Skills (PPST)                                     Date Taken:                                     Score:

Reading:

Writing:

Math:
                                                       Praxis II Licensure Area Tests
        Teaching Licensure Area                                    Test Code and Name                                           Test Score




  Primary License Area- the license area in which you are most likely to teach.                     Teaching Methods will be provided in this area.
List Primary Licensure Area:


                           Required Additional Coursework (if necessary, depending on license area)
□ Yes, I plan to pursue a license in Early Childhood, Middle Childhood or Secondary Social Studies and I have taken or I am currently enrolled
in an Arkansas History (3-credit hour college/university level class) to be completed by May 31st.

□ Yes, I plan to pursue a license in Early Childhood, or Middle Childhood and I have taken or I am currently enrolled in the Methods of
Teaching Reading courses approved by the Arkansas Department of Education (6-credit hours college/university level classes) to be completed
by May 31st.


College/University where currently enrolled or completed required Arkansas
                                                                                               If completed, indicate letter grade achieved:
History course:
College/University where currently enrolled or completed required Methods of
                                                                                               If completed, indicate letter grade achieved:
Teaching Reading I course:

College/University where currently enrolled or completed required Methods of
                                                                                               If completed, indicate letter grade achieved:
Teaching Reading II course:
                                                         Criminal Background Check
□ Yes, I have initiated the process of conducting the required State and Federal Criminal Background Checks and DHS Child Maltreatment
Central Registry.
*If you have not started this process, you may obtain the Criminal Background Check forms from any local school district office or the Arkansas Department of
Education. See www.teacharkansas.org click Non-Traditional Licensure, click Before You Apply, click Background Checks for the DHS form.
                                                First Year NTLP Fee Payment Agreement
 □ I understand that payment of the NTLP fee of $1200.00 is due in full after the May orientation once a final decision has been made to
definitely attend instructional modules. I will pay the fee by cashier’s check or money order (no personal checks or cash) during the payment
window of May 24, 2010 and June 7, 2010. Payment will be made prior to attending any NTLP instructional modules. I understand that I am not
eligible for a refund if I attend any portion of any instructional module.
                                              Second Year NTLP Fee Payment Agreement
□ I understand that payment of the NTLP fee of $1200.00 is due in full NO LATER THAN June 15, 2010.            I will pay the fee by cashier’s check
or money order (no personal checks or cash) during the payment window of May 24, 2010 and June 15, 2010. Payment will be made prior to
attending any NTLP instructional modules. I understand that I am not eligible for a refund if I attend any portion of any instructional module.
                                                             Privacy Act Disclosure
□ Yes, I hereby authorize the Arkansas Department of Education to use the information on this application for program purposes, to post my
contact information on the www.teacharkansas.org website and/or share my contact information with potential employers.
                           Mandatory Attendance Acknowledgment (First Year Applicants Only)
□” I understand and agree to the following: 1) If I am admitted to the NTLP I am required to attend an orientation in May 2010 and MUST be
available to attend 10 days of summer instructional modules at my assigned regional site and 5 days of instruction at a Central Arkansas
location. 2) I am responsible for making housing arrangements for the five days of modules in Central Arkansas. 3) Attendance at all
instructional modules is MANDATORY without exception.”

                                              NTLP Rules and Policies Acknowledgement
□ I agree to adhere to all rules and policies governing the NTL program. I acknowledge that I may be administratively withdrawn from the
program for violation of said rules and policies.
                                                 Haberman STAR Teacher Pre-Screener
□” I understand that once I have submitted my NTLP application and packet and have been admitted to the program I will receive information
regarding the Haberman STAR Teacher Pre-Screener. I understand that I MUST complete this evaluation as part of the NTLP application
process.




   I certify that the information I have provided here is true to the best of my knowledge. I understand that submission of the application
   without submission of all required documentation (packet) will cause the application to be denied. I agree to inform NTLP if I am hired
   in a teaching position or if I choose to withdraw my application.


             _______________________________________________                                          ___________________________
                           Signature of Applicant                                                                 Date
The following items are required to make your application complete:

     Official Transcript(s) showing 4-year degree conferred (copies of the original documents will not be accepted)
     Official Transcript(s) showing completed required additional courses (if ECH, MCH or Secondary Soc. Studies) OR
     Official proof from college/university showing current enrollment in the required additional courses

     Originals of Praxis I scores (copies of the original documents will not be accepted)
     Printed copy of Praxis II scores (from ETS website account)
     Proof of initiating the State and Federal Criminal Background Checks (copy of ASP-122 form and fingerprint card or
      cancelled checks)
     Proof of initiating the DHS Child Maltreatment Central Registry background check ( copy of completed and notarized
      form)

     Payment of NTLP program fee by Cashier’s check or money order for $1200.00 program fee made out to ADE-NTLP
      10-11 (due NO LATER THAN June 7, 2010).


NOTE: Incomplete applications will not be accepted.

Mail these items to:

ADE-NTLP 10-11
501 Woodlane, Suite 220 C
Little Rock, Arkansas 72201

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:71
posted:11/14/2010
language:English
pages:5
Description: Legal Aide for Bentonville Arkansas document sample