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#24-009009-0010
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.

Do you currently possess certification/licensure in any of the following subject areas?
Early Childhood Education
Elementary Education
English
Reading Teacher
Reading Specialist
None of the above
3.

Do you have experience in identifying and using reading assessment and diagnostic tools?  If yes, please provide details below.  If no, please write “N/A.”
4.

Do you have knowledge of the ARC Core framework?  If yes, please provide details below.
5.

Do you have experience designing and providing professional development?  If yes, please provide details below.

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