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    x The teacher appreciates the cultural dimensions of communication, responds appropriately, and seeks to foster culturallysensitive communication by and among all students in the class.

    Skills

    x The teacher models effective communication strategies in conveying ideas and information and in asking questions (e.g.monitoring the effects of messages, restating ideas and drawing connections, using visual, aural, and kinesthetic cues,being sensitive to nonverbal cues given and received).

    x The teacher supports and expands learner expression in speaking, writing, and other media.

    x The teacher knows how to ask questions and stimulate discussion in different ways for particular purposes, for example,probing for learner understanding, helping students articulate their ideas and thinking processes, promoting risk-taking andproblem-solving, facilitating factual recall, encouraging convergent and divergent thinking, stimulating curiosity, helpingstudents to question.

    x The teacher communicates in ways that demonstrate sensitivity to cultural and gender differences (e.g. appropriate use of eye contact, interpretation of body language and verbal statements, acknowledgment of and responsiveness to differentmodes of communication and participation).

    x The teacher knows how to use a variety of media communication tools, including audio-visual aids and computers, to enrichlearning opportunities.

    Principle #7: The teacher plans instruction based upon knowledge of subject matter, students, thecommunity, and curriculum goals.

    Knowledge

    x The teacher understands learning theory, subject matter, curriculum development, and student development and knowshow to use this knowledge in planning instruction to meet curriculum goals.

    x The teacher knows how to take contextual considerations (instructional materials, individual student interests, needs, andaptitudes, and community resources) into account in planning instruction that creates an effective bridge betweencurriculum goals and students' experiences.

    x The teacher knows when and how to adjust plans based on student responses and other contingencies.

    Dispositions

    x The teacher values both long term and short term planning.

    x The teacher believes that plans must always be open to adjustment and revision based on student needs and changingcircumstances.

    x The teacher values planning as a collegial activity.

    Skills

    x As an individual and a member of a team, the teacher selects and creates learning experiences that are appropriate forcurriculum goals, relevant to learners, and based upon principles of effective instruction (e.g. that activate students' priorknowledge, anticipate preconceptions, encourage exploration and problem-solving, and build new skills on those previouslyacquired).

    x The teacher plans for learning opportunities that recognize and address variation in learning styles and performance

    modes.

    x The teacher creates lessons and activities that operate at multiple levels to meet the developmental and individual needs of diverse learners and help each progress.

    x The teacher creates short-range and long-term plans that are linked to student needs and performance, and adapts theplans to ensure and capitalize on student progress and motivation.

    x The teacher responds to unanticipated sources of input, evaluates plans in relation to short- and long-range goals, andsystematically adjusts plans to meet student needs and enhance learning.

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    Principle #8: The teacher understands and uses formal and informal assessment strategies toevaluate and ensure the continuous intellectual, social and physical development of the learner.

    Knowledge

    x The teacher understands the characteristics, uses, advantages, and limitations of different types of assessments (e.g.criterion-referenced and norm-referenced instruments, traditional standardized and performance-based tests, observationsystems, and assessments of student work) for evaluating how students learn, what they know and are able to do, andwhat kinds of experiences will support their further growth and development.

    x

    The teacher knows how to select, construct, and use assessment strategies and instruments appropriate to the learningoutcomes being evaluated and to other diagnostic purposes.

    x The teacher understands measurement theory and assessment-related issues, such as validity, reliability, bias, and scoringconcerns.

    Dispositions

    x The teacher values ongoing assessment as essential to the instructional process and recognizes that many differentassessment strategies, accurately and systematically used, are necessary for monitoring and promoting student learning.

    x The teacher is committed to using assessment to identify student strengths and promote student growth rather than todeny students access to learning opportunities.

    Skills

    x The teacher appropriately uses a variety of formal and informal assessment techniques (e.g. observation, portfolios of student work, teacher-made tests, performance tasks, projects, student self-assessments, peer assessment, andstandardized tests) to enhance her or his knowledge of learners, evaluate students' progress and performances, and modifyteaching and learning strategies.

    x The teacher solicits and uses information about students' experiences, learning behavior, needs, and progress fromparents, other colleagues, and the students themselves.

    x The teacher uses assessment strategies to involve learners in self-assessment activities, to help them become aware of their strengths and needs, and to encourage them to set personal goals for learning.

    x The teacher evaluates the effect of class activities on both individuals and the class as a whole, collecting informationthrough observation of classroom interactions, questioning, and analysis of student work.

    x The teacher monitors his or her own teaching strategies and behavior in relation to student success, modifying plans andinstructional approaches accordingly.

    x The teacher maintains useful records of student work and performance and can communicate student progressknowledgeably and responsibly, based on appropriate indicators, to students, parents, and other colleagues.

    Principle #9: The teacher is a reflective practitioner who continually evaluates the effects of his/herchoices and actions on others (students, parents, and other professionals in the learning community)and who actively seeks out opportunities to grow professionally.

    Knowledge

    x The teacher understands methods of inquiry that provide him/her with a variety of self- assessment and problem-solvingstrategies for reflecting on his/her practice, its influences on students' growth and learning, and the complex interactionsbetween them.

    x The teacher is aware of major areas of research on teaching and of resources available for professional learning (e.g.professional literature, colleagues, professional associations, professional development activities).

    Dispositions

    x The teacher values critical thinking and self-directed learning as habits of mind.

    x The teacher is committed to reflection, assessment, and learning as an ongoing process.

    x The teacher is willing to give and receive help.

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    x The teacher is committed to seeking out, developing, and continually refining practices that address the individual needs of students.

    x The teacher recognizes his/her professional responsibility for engaging in and supporting appropriate professional practicesfor self and colleagues.

    Skills

    x The teacher uses classroom observation, information about students, and research as sources for evaluating the outcomesof teaching and learning and as a basis for experimenting with, reflecting on, and revising practice.

    x The teacher seeks out professional literature, colleagues, and other resources to support his/her own development as alearner and a teacher.

    x The teacher draws upon professional colleagues within the school and other professional arenas as supports for reflection,problem-solving and new ideas, actively sharing experiences and seeking and giving feedback.

    Principle #10: The teacher fosters relationships with school colleagues, parents, and agencies in thelarger community to support students' learning and well-being.

    Knowledge

    x The teacher understands schools as organizations within the larger community context and understands the operations of the relevant aspects of the system(s) within which s/he works.

    x The teacher understands how factors in the students' environment outside of school (e.g. family circumstances, communityenvironments, health and economic conditions) may influence students' life and learning.

    x The teacher understands and implements laws related to students' rights and teacher responsibilities (e.g. for equaleducation, appropriate education for handicapped students, confidentiality, privacy, appropriate treatment of students,reporting in situations related to possible child abuse).

    Dispositions

    x The teacher values and appreciates the importance of all aspects of a child's experience.

    x The teacher is concerned about all aspects of a child's well-being (cognitive, emotional, social, and physical), and is alert tosigns of difficulties.

    x The teacher is willing to consult with other adults regarding the education and well-being of his/her students.

    x The teacher respects the privacy of students and confidentiality of information.

    x The teacher is willing to work with other professionals to improve the overall learning environment for students.

    Skills

    x The teacher participates in collegial activities designed to make the entire school a productive learning environment.

    x The teacher makes links with the learners' other environments on behalf of students, by consulting with parents,counselors, teachers of other classes and activities within the schools, and professionals in other community agencies.

    x The teacher can identify and use community resources to foster student learning.

    x The teacher establishes respectful and productive relationships with parents and guardians from diverse home andcommunity situations, and seeks to develop cooperative partnerships in support of student learning and well being.

    x The teacher talks with and listens to the student, is sensitive and responsive to clues of distress, investigates situations,and seeks outside help as needed and appropriate to remedy problems.

    x The teacher acts as an advocate for students.

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    EVALUATION OF THE STUDENT TEACHER ____________________________________________________________________________________

    Evaluation should be an ongoing process for the growth and development of the student teacher. The Cooperating Teacher, theUniversity Supervisor and the Student Teacher share this responsibility. Evaluation focuses on identifying areas of strength andweakness and suggesting strategies and techniques for more effective teaching. The student teacher is then able to capitalize onstrengths while eliminating the weaknesses. Goals need to be set and specific objectives established to enable the student teacher to have optimal development.

    Grading is the culmination of the evaluation process. A judgment is made concerning the degree to which a student has metspecified goals and objectives and the degree of attainment of both the generic and teaching field competencies. Although a grade

    for the experience is important, it is not the only indicator of the student's ability to teach but grades do give a general indication of the quality of the student's achievement.

    In assigning a grade, the following statements may be helpful:

    A - Represents superior teaching signifying excellence. This signifies that the candidate exhibits teaching competencies in acontinuous and spontaneous manner. Student teachers who are rated A have achieved a "higher level" of competency. Thesestudents can be expected to develop into outstanding teachers.

    B - Represents good teaching. A student teacher receiving a B has achieved a "moderate level" of competency. The candidateshould be expected to maintain that level of performance and perhaps even approach excellence as he/she gains experienceand is mentored to facilitate continued growth.

    C - Represents minimally acceptable teaching. A student teacher rated a C has achieved a "low level" of competency. Thestudent teacher is eligible for certification but may not carry a recommendation of professional competence. In a competitivemarket, the candidate may find it difficult to obtain a teaching position.

    D - Represents inadequate teaching skills indicated by not achieving the majority of competencies listed on the evaluationform. The student teacher WILL NOT be certified but will be able to graduate from IUP without certification.

    F - Represents failure. No credit will be given.

    Please work closely with the University Supervisor before deciding on a final grade for your student teacher. Your UniversitySupervisor is the instructor of record and has worked with student teachers in many different settings and classroom situations --together a mutually agreeable, objective assessment of the performance can be achieved . It is statistically unlikely andunrealistic to expect that all candidates will meet the competency level to receive an "A" grade. A grade of "B" is quite frequentlyindicated. Grades of "C" and "D" occur much less frequently. Grades must honestly and professionally reflect the competencyattainment of the student teacher.

    The letter grade is just one measure of the candidate's ability. Equally important to the evaluation process is the checklist of competency attainment on the evaluation form as well as the written comments which afford the opportunity to indicate specificstrengths, weaknesses, and potential of the prospective teacher.

    The evaluation form and performance indicators for both the Minimal Generic Teacher Education Competencies (green sheet) andthe Minimal Teaching Field Competencies (yellow sheet) will assist you in your evaluation process. Work closely with your student teacher to develop the competencies and with your University Supervisor to evaluate the competencies.

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    MID-TERM EVALUATIONS

    An evaluation takes place during the mid-term of the assignment using the PDE Form 430. Where student teachers are assignedfor a quarter, e.g., art, health and physical education, home economics, hearing loss, special education, and music, it is advisable toconduct an informal evaluation about the fourth week of the experience. This is to assist the student teacher in being reflective aswell as understanding what is expected in order to reach optimal success by the end of the quarter. This informal evaluation is to beshared with the university supervisor and student. For those candidates who have a semester assignment, the mid-term evaluationwill take place about the seventh week of the experience using the PDE Form 430. This evaluation should contain a tentative gradeand specific suggestions for improvement so that optimal success can be achieved by the end of the semester. This evaluation is to

    be completed and signed by the cooperating teacher, the university supervisor, and the student teacher during a three-wayconference. The student teacher should be encouraged to reflect on his/her performance. A copy is to be sent to the Teacher Education Office where it will be placed in the student teacher's file. The evaluation is composed of three parts: Part I, a checklistof generic and specific competencies; Part II, a checklist of departmental competencies, and Part III, a page for narrative evaluativestatements. After the checklist is completed, the student teacher should reflect on the competency sheets and the performanceindicators for each of the competencies.

    FINAL EVALUATIONS

    A final evaluation conference should be scheduled with the student teacher to review Part I, Part II and Part III of the evaluationform. The purpose of this conference is to thoroughly review and explain the ratings as well as share strengths and suggestions for improvement. After consultation with the university supervisor, the grade may be given to the student teacher . A studentteacher should include a personal evaluation of his/her performance on the signed evaluation form and PDE Form 430. Thesignature indicates that the student teacher has read, and has had an opportunity to discuss the evaluation. The university supervisor will assist the cooperating teacher in the procedures for completing and reviewing the evaluation as well as how he/she desires theevaluation be submitted to IUP, e.g., some university supervisors are available for the final conference while some review thenarrative evaluation and projected grade and request the conference be completed by the cooperating teacher and the entireevaluation packet be mailed to their university address so that the university supervisor can complete it. The university supervisor is responsible for distribution of the copies to the appropriate persons or office. The evaluations submitted to the Teacher Education Office are kept on file for a period of time -- usually five years. Family Educational Rights and Privacy Act (BuckleyAmendment) prohibits IUP from mailing out any student observations or evaluations to any prospective employer without thewritten consent of the student teacher.

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    Appendix F

    EDUC 421, 431 and/or 441: Student Teaching

    Course Syllabus

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    Course Syllabus

    EDUC 421, 431 and/or 441 Student Teaching

    Course Description: Experience in teaching at the elementary or secondary level; coordination and visitation by a universityfaculty member with daily supervision by a cooperating teacher. Efforts are made to provide opportunities for Candidates towork with students who have special needs and/or who come from diverse cultural backgrounds.

    Conceptual Framework Relation

    This capstone culminating experience is one that calls for the candidate with guided independence to integrate the componentsof the Danielson Framework-Professional Responsibilities, Planning and Preparation, Instruction, and Classroom Environmentinto the environment of the classroom where student teaching occurs.

    Pre-Requisites for the Course

    Candidates enrolled in student teaching have met all requirements of the first two steps of the IUP Three Step Process toTeacher Certification including:

    x Admitted to the Teacher Certification Programx Attainment of Step 2 in the IUP 3 Step Processx Satisfactory completion of at least 91 semester hoursx

    Cumulative grade point average of 3.0 or higher x Completion of liberal studies requirement courses with a "C" or better x Completion of all required professional education courses with a minimum grade of "C" in each

    these include: COMM 301 or departmental equivalent, EDUC 442, EDUC 242, EDUC 342, EDSP 477x Completion of the Special Education Competency course EDEX 300/301x Current Clearance for Act 34 and Act 151x FBI Fingerprintingx Liability insurancex Negative TB Test verificationx Affirmative recommendation by the student's major departmental adviser or program coordinator

    Course Outcomes

    The outcomes and performance indicators listed below are the generic outcomes for all education majors. In addition to theseoutcomes there are separate outcomes and performance indicators for each of the 20 certification programs available at IUP.

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    Appendix G

    Generic EvaluationPart I and Part III

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    Part I

    Teacher Education: Evaluation of Student TeachingStudent's Name ___________________________________ Banner ID @___________________ Date__________________________

    IUP Department _____________________________Grades Taught _____________________ Subjects or Program _____________________

    School District _________________________________________ School Building __________________________________________________

    Check Appropriate Blocks 1st Experience 2nd Experience Midterm Final

    Based on observation of your student teachers performance and/or examination of his/her records and other product outcomes, please assesshis/her development of the following competencies as an entry level teacher. Please make heavy black marks in the squares for the rating of thecompetency level. Refer to the suggested list of performance indicators on the separate outcomes sheet to assist in the evaluation process. These

    performance indicators are not finite.

    Superior (SU) -- -Beyond what is expected at this point in the program Needs Improvement (NI) -- -Less than expected at this point in the program

    Satisfactory (S) ---As expected at this point in the program NOTA ---- No Opportunity To Assess

    Minimal Generic Teacher Education Outcome SU S NI NOTA1. The teacher understands the central concepts, tools of inquiry, and structures of the discipline(s)

    he or she teaches and can create learning experiences that make these aspects of subject matter meaningful for students.

    2. The teacher understands how children learn and develop, and can provide learning opportunitiesthat support their intellectual, social and personal development.

    3. The teacher understands how students differ in their approaches to learning and createsinstructional opportunities that are adapted to diverse learners.

    4. The teacher understands and uses a variety of instructional strategies to encourage students

    development of critical thinking, problem solving, and performance skills.5. The teacher uses an understanding of individual and group motivation and behavior to create a

    learning environment that encourages positive social interaction, active engagement in learning,and self-motivation.

    6. The teacher uses knowledge of effective verbal, nonverbal, and media communication techniquesto foster active inquiry, collaboration, and supportive interaction in the classroom.

    7. The teacher plans instruction based upon knowledge of subject matter, students, the community,and curriculum goals.

    8. The teacher understands and uses formal and informal assessment strategies to evaluate andensure the continuous intellectual, social and physical development of the learner.

    9. The teacher is a reflective practitioner who continually evaluates the effects of his/her choicesactions on others (students, parents, and other professionals in the learning community) and whoactively seeks out opportunities to grow professionally.

    SUMMARY - OVERALL RATINGThe original to: Teacher Education Office - 104 Stouffer Hall.

    Photocopies should be provided to the following:

    Student Teacher/Cooperating Teacher/University Supervisor.

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    Indiana, Pennsylvania 15705 Part III

    Name Department ________________________________________________ (Please Type)

    Cooperating Teacher: ________________________________________________________

    ______________________________________ _______________ _____________________ Signature of Cooperating Teacher Date Recommended Grade

    University Supervisor: ________________________________________

    ________________________________________ ______________ ____________________

    Signature of University Supervisor Date Midterm/Final Grade

    Student Teacher: ____________________________________________

    I have had the opportunity to meet with my cooperating teacher and university supervisor to discuss this evaluation.

    ______________________________________________ ____________________________ Signature of Student Teacher Date

    GENERIC.EVLREV 7/02

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    Appendix H

    Guest Host Form

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    TEACHER EDUCATIONSTUDENT TEACHING

    GUEST-HOST RELATIONSHIP FORM

    The College of Education works with a large number of school districts each year in connection withfield experiences for pre-student teaching and student teaching programs. In each instance, we are able

    to place teacher education candidates in a particular district because the district has invited us to place

    prospective teachers and has agreed to work cooperatively with us in a particular segment of the

    teacher education program. Consequently, both pre-student teachers and student teachers participating

    in field experience activities in a school district do so as guests of the school district.

    Each school district has regulations, procedures, institutional practices, and professional expectations

    for school district personnel, which will apply to pre-student teachers and student teachers assigned to

    a field experience in a school district. It is the responsibility of each pre-student teacher and student

    teacher to become aware of the expectations, rules and codes of conduct for teachers and student

    teachers.

    A teacher education candidate enrolling in a course which requires an assignment to a field experience

    as a pre-student teacher and/or as a student teacher must understand that he/she will be in a school

    district as a guest of that district. Further, the acceptance of a pre-student teacher or student teaching

    assignment indicates an understanding of this guest/host relationship and an understanding that the

    teacher education candidate is expected to abide by the regulations, procedures, institutional practices,and professional expectations of the particular school district in which an assignment has been

    accepted.

    _________________________________________________________________________

    As a teacher education candidate, I understand and agree to the principles governing field experiences.

    Further, I understand and agree that if my conduct or performance as a pre-student teacher or student

    teacher is not compatible with the regulations, policies, institutional practices, or professional

    expectations of the host school district or the university, my assignment may be terminated upon

    request of either the University or the school district.

    _______________________________ Date

    _______________________________ Candidate Signature

    _______________________________ Please Print Name

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    Appendix I

    PA Standard Application &

    Directions(Application is interactive on the PDE website at: www.pde.state.pa.us )

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    STANDARD APPLICATION

    For Teaching Positions in Pennsylvania Public Schools

    (P LEASE P RINT OR T YPE )

    Position(s) Desired

    NameLAST FIRST MIDDLE SOCIAL SECURITY NUMBER 1

    Present AddressSTREET (AREA CODE ) TELEPHONE

    CITY STATE ZIP CODE

    PERMANENT ADDRESS STREET (AREA CODE ) TELEPHONE

    CITY STATE ZIP CODE

    E- MAIL ADDRESS (IF AVAILABLE )

    L IST , IN ORDER OF PREFERENCE , THE GRADES , SUBJECTS AND /OR POSITIONS FOR WHICH YOU ARE APPLYING :

    1. 2. 3.

    CERTIFICATION(LIST ALL AREAS IN WHICH YOU HOLD VALID PENNSYLVANIA AND /OR OUT -OF-STATE TEACHING CERTIFICATES . NOTE : APPLICANTSHOLDING A CERTIFICATE FROM ANOTHER STATE MUST OBTAIN A PENNSYLVANIA CERTIFICATE IN ORDER TO TEACH IN PENNSYLVANIA

    PUBLIC SCHOOLS .)AREA OF C ERTIFICATION ISSUING STATE DATE ISSUED

    HAVE YOU ACQUIRED TENURE IN PENNSYLVANIA ?

    IF YES , IN WHAT SCHOOL DISTRICT ?

    DATE AVAILABLE FOR EMPLOYMENT

    IF YOU ARE NOT EMPLOYED FULL TIME , ARE YOU INTERESTED IN BEING PLACED ON OUR SUBSTITUTE LIST? YES NOLONG -TERM YES NO SHORT -TERM YES NO

    737345 Federal Privacy Act [5 U.S.C.552A NOTE] Statement. Authority for requesting social security accountnumbers: Public School Code of 1949 [24 P.S. 12-1212, 24 P.S. 1224] Principal Purpose: To verifycertification. Other Purposes: Identification and collection of criminal/disciplinary records for certifiededucators. Disclosure: Mandatory. Failure to provide the Social Security Number will result in an applicantnot being considered for employment.

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    EDUCATIONAL BACKGROUND

    School or Institution and LocationMajor/Minor

    DIPLOMAS ,DEGREES OR

    C REDITS E ARNED

    G RADE P OINTAverage(GPA)

    HIGH SCHOOLCOLLEGE /U NIVERSITY COLLEGE /U NIVERSITY

    GRADUATE STUDY GRADUATE STUDY

    EXPERIENCE(PRESENT OR MOST RECENT FIRST )

    Dates Name of Employer and Address Your Title

    From

    To (Area Code) Telephone:Work Performed: Reason for Leaving:

    Name & Title of Supervisor:

    Final YearlySalary:

    Dates Name of Employer and Address Your Title

    From

    To (Area Code) Telephone:Work Performed: Reason for Leaving:

    Name & Title of Supervisor:

    Final YearlySalary:

    Dates Name of Employer and Address Your Title

    From

    To (Area Code) Telephone:Work Performed: Reason for Leaving:

    Name & Title of Supervisor:

    Final YearlySalary:

    Please list activities that you are qualified to supervise or coach:

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    If you have not been previously employed in a teaching position, please complete the following:

    STUDENT OR PRACTICE TEACHING

    G RADE OR SUBJECTT AUGHT

    NAME AND ADDRESS OF SCHOOL 1. C OLLEGE SUPERVISOR 2. C OOPERATING T EACHER

    1.

    2.

    1.

    2.

    Student Teaching References:Please attach photocopies of letters of reference and/or evaluations from college/university student teacher supervisor and cooperating teacher(s).

    REFERENCES

    References should include superintendents, principals or professors who have first-handknowledge of your professional competence and your personal qualifications.

    Experienced teachers should include the superintendent and principal of the two mostrecent schools in which employed. If any person(s) listed should not be contacted forreference at the present time, indicate in the left-hand margin the date contact(s) may bemade.

    NAME P OSITION ADDRESS T ELEPHONE

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    OTHER QUALIFICATIONSSummarize special job-related skills and qualifications acquired from employment or other experiences(including U.S. military service) and/or state any additional information you feel may be helpful inconsidering your application, i.e. honors, awards, activities, technology skills or professional developmentactivities:

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    GENERAL BACKGROUND INFORMATION

    You must give complete answers to all questions. If you answer "Yes" to any question, you must list alloffenses, and for each conviction provide date of conviction and disposition, regardless of the date or locationof occurrence. Conviction of a criminal offense is not a bar to employment in all cases. Each case isconsidered on its merits. Your answers will be verified with appropriate police records.

    Criminal Offense includes felonies, misdemeanors, summary offenses and convictions resulting from a plea of "nolo contendere" (no contest).

    Conviction is an adjudication of guilt and includes determinations before a court, a district justice or amagistrate, which results in a fine, sentence or probation.

    You may omit: minor traffic violations, offenses committed before your 18th birthday which wereadjudicated in juvenile court or under a Youth Offender Law, and any convictions which have been expunged

    by a court or for which you successfully completed an Accelerated Rehabilitative Disposition program.

    Were you ever convicted of a criminal offense? Yes No

    Are you currently under charges for a criminal offense? Yes No

    Have you ever forfeited bond or collateral in connection with a criminaloffense?

    Yes No

    Within the last ten years, have you been fired from any job for any reason? Yes No

    Within the last ten years, have you quit a job after being notified that youwould be fired?

    Yes No

    Have you ever been professionally disciplined in any state?

    Professional disciplined means the annulment, revocation or suspension of your teaching certification or having received a letter of reprimand from anagency, board or commission of state government, such as the PennsylvaniaProfessional Standards and Practices Commission.

    Yes No

    Are you subject to any visa or immigration status, which would preventlawful employment?

    Yes No

    Note: If you answered "Yes" to any of the above questions, please provide a detailed explanation on a separate sheet of paper, including dates, and attach it to this application. Please print and sign your name on the sheet, andinclude your social security number.

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    79

    ACT 34 COMPLIANCE (Background Check of Prospective Employees)

    Each applicant must submit with the employment application a State and Federal criminal history report or a copyof the completed form/request.

    ************************************************

    ACT 151 (PA Child Abuse History Clearance)

    Each candidate must submit with his/her employment application a copy of an official clearance statementobtained from the Pennsylvania Department of Public Welfare or a statement from the Department of PublicWelfare that no record exists. The clearance statement must be no more than one (1) year old. The applicantMUST submit the ORIGINAL report prior to employment.

    *******************************************

    ESSAY

    Please write an essay as described on page six. For your convenience, you may attach a sheet; however, your essay may not exceed one page. At the bottom of the attachment, please print and sign your name.

    *******************************************

    CERTIFICATION AND RELEASE AUTHORIZATION

    I certify that all of the statements made by me are true, complete and correct to the best of my knowledge and belief, and aremade in good faith. I further certify that I am the sole author of the essay. I understand that any misrepresentation of

    information shall be sufficient cause for: (1) rejecting my candidacy, (2) withdrawing of any offer of employment, or (3)terminating my employment.

    I hereby authorize any and all of my previous employers and/or supervisors to release any and all of my personnel records, andto respond fully and completely to all questions that officials of____________ (school district) may ask regarding my prior

    work history and performance. I will hold such previous employers and/or supervisors harmless of any and all claims that Imight otherwise have against them with regard to statements made to this school district. I further authorize these officials to

    investigate my background, now or in the future, to verify the information provided and release from liability all persons and/or entities supplying information regarding my background. However, I do not authorize the production of medical records or

    other information, which would tend to actually identify a disability nor do I authorize inquiries which would includeinformation related to any medical condition or medical history. Further, I do not waive any rights which I may have under

    state or federal law related to my right to challenge the disclosure of unlawful or inaccurate information, whether by the schooldistrict or by entities or persons providing such information to the school district, including any and all claims concerningallegations of employment discrimination because of race, color, sex, religion, national origin, ancestry, age or disability.

    Date Signature of Candidate (in ink)

    [Must be original] Pennsylvania school distric ts shall no t discriminate in their educational programs, activities or employment practices based on race, color, na tional origin, sex, disability, age, relig ion, ancestry or any other legally protected classification. This policy is in accordance with state and federal laws, including TitleVI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Sections 503 and 504 of the Rehabilitation Act of 1973, the Age

    Discrimination Act of 1975, the Americans with Disabilities Act of 1990 and the Pennsylvania Human Relations Act. Information relative to special accommodation, grievance procedure, and the designated responsible official for compliance with Title VI, Title IX, and Section 504 may be obtained bycontacting the school district.

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    80ESSAY

    We are interested in your ability to organize and express thoughts on a specific topic in a succinct manner. Pleaseselect one of the following topics and write an essay in the space provided on this page.

    1. The Most Important Qualities of an Outstanding Educator.2. My Philosophy of Student Discipline.3. The Importance of Continuing Professional Development and How I Plan to Incorporate It Throughout

    My Career.4. Essential Elements of Instruction, Administration or Area of Certification.5. How Information Technology (i.e., computers, Internet) Can Be Integrated into the Instructional Process

    and Curriculum.


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