Академический Документы
Профессиональный Документы
Культура Документы
cit
!i" c#de
T# t&e em"l#
(#) A
,c&##l s stem P$%lic
er' Please return this form to the employee. Do not send it directly to the Licensure Section. Pr#fessi#nal Ed$cat#r *K-12+ E)"erience *t# %e c#m"leted % em"l# er+
(e.innin. date #f ser-ice *m#nt&/ da / ear+ Endin. date #f ser-ice *m#nt&/ da / ear+ T#tal &#$rs 0#r1ed "er 0ee1 f$ll-time "art-time P#siti#n title *e2.2/ teac&er/ c#$nsel#r/ s$"er-is#r/ "rinci"al/ s$"erintendent+
Pri-ate
Box B
,c&##l s stem
K-12 Instructional Teacher ssistant !xperience "to #e completed #y employer$ (e.innin. date #f ser-ice *m#nt&/ da / ear+ Endin. date #f ser-ice *m#nt&/ da / ear+ T#tal &#$rs 0#r1ed "er 0ee1 I%P&'T (T) C&ec1 #ne %#) %el#0 f#r eac& assi.nment2
T&e assi.nment meets t&e criteria statement3 %el#02
N# N# N# N# N#
*+'IT!'I ST T!%!(T) The instructional teaching assistant assignment listed above was service in the classroom with school-age children with actual instructional teaching responsibilities comprising a minimum of 50% of daily activities.
I certif t&at t&is -erificati#n #mits lea-e #f a%sence "eri#ds and t&at all inf#rmati#n is c#m"lete and c#rrect acc#rdin. t# t&e #fficial rec#rds #f t&is sc&##l s stem2
date
address
title
P$%lic ,c&##ls #f N#rt& Car#lina De"artment #f P$%lic Instr$cti#n 5icens$re ,ecti#n 6768 9ail ,er-ice Center Ralei.&/ N#rt& Car#lina 2:6;;-6768
tele"&#ne
4#$ ma "a % "ers#nal c&ec1/ m#ne #rder/ certified c&ec1 made "a a%le t# t&e De"artment #f P$%lic Instr$cti#n/ Visa #r 9astercard 2 If #$ 0is& t# "a % credit card/ fill #$t t&e credit card "a ment f#rm and mail t# t&e a%#-e address #r fa) it t# *;1;+ =<:778<2 >i.&li.&ted inf#rmati#n is %lac1ed #$t and $nreada%le % #$r di.ital scannin. s stem2 Please d# n#t $se &i.&li.&ters #f an c#l#r #n #$r d#c$ments2 >i.&li.&ted d#c$ments ma %e ret$rned t# #$2
Please d# n#t f#ld/ sta"le/ #r $se "a"er cli"s t# #r.ani!e t&ese materials2 D#in. s# 0ill sl#0 d#0n t&e a$t#mated a""licati#n "r#cess and dela #$r res"#nse2 Please mail t&e d#c$ments in a ;A ) 12A en-el#"e2 T&an1 #$2
N#te'
N#n-teac&in. B#r1 E)"erience can n#t %e re?$ested $sin. t&is f#rm2 Re?$ests f#r N#n-teac&in. B#r1 E)"erience m$st %e s$%mitted t&r#$.& t&e "ers#nnel #ffice #f t&e em"l# in. NC sc&##l s stem $sin. F#rm NE2
P$%lic ,c&##ls #f N#rt& Car#lina De"artment #f P$%lic Instr$cti#n 5icens$re ,ecti#n 6768 9ail ,er-ice Center Ralei.&/ N#rt& Car#lina 2:6;;-6768
A$.$st 2<<=