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Assessment Section Committee Application
Assessment Section Committee Application
* required field
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Day
Year
2020
2021
2022
2023
2024
Year
Served
*
Have you applied to serve on an ADE committee in the past 2 years?
Yes
No
Not Sure"
Name
First Name
*
Last Name
*
Preferred Name
Address
St Address
*
Street Address
City
*
State
Arizona
Other
Zip
*
Contact Information
Work Email
*
Personal Email
*
Work Phone
EXT
Other Phone
Demographic Information
Gender
*
Male
Female
Ethnicity
*
- Select -
Asian
Black
Hispanic or Latino
Native American
White
Other, please specify
Ethnicity Other
*
Please fill in ethnicity if not listed above.
Education Experience
Current Cert
*
Current Certification(s) – select all that apply by holding Control or Command with your selections
Elementary
Secondary
Special Education
Administrative - Principal Superintendent
None
Other
Endorsement
Endorsements and Specialization(s) – please specify (e.g., Mathematics or Reading Specialist, English as a Second Language (ESL), Gifted, Structured English Immersion (SEI), Special Ed, etc.)
Years in Classroom
Indicate years of classroom teaching experience
Current Position
*
Current position: Specify Grade(s)/subject(s), or district position
School Name
*
District
*
Type of Area
*
Urbanized Areas (UAs) of 50,000 or more people
Urban Clusters (UCs) of at least 2,500 and less than 50,000 people
“Rural” encompasses all population, housing, and territory not included within an urban area
Specify type of area where you teach/work. For an individual school, the rural/urban classification can be determined by its mailing address using the Census Bureau’s American FactFinder. http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml#none
Committee Preferences
(2 sections below: Content Areas and Grade Levels)
Content areas preferred
Content areas preferred, qualified for Mark choices in order of preference (1st and 2nd choices are required)
1st Choice
*
- Select -
Alternate Assessment/Special Education
Braille
English Language Learners (ELL)
English Language Arts (ELA)
Mathmatics
Science
2nd Choice
*
- Select -
Alternate Assessment/Special Education
Braille
English Language Learners (ELL)
English Language Arts (ELA)
Mathmatics
Science
3rd Choice
- None -
Alternate Assessment/Special Education
Braille
English Language Learners (ELL)
English Language Arts (ELA)
Mathmatics
Science
4th Choice
- None -
Alternate Assessment/Special Education
Braille
English Language Learners (ELL)
English Language Arts (ELA)
Mathmatics
Science
Grade levels preferred
Grade levels preferred, qualified for Mark choices in order of preference (1st and 2nd choices are required)
1st Choice
*
- Select -
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th and 12th Grades
Adult Ed
2nd Choice
*
- Select -
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th and 12th Grades
Adult Ed
3rd Choice
- None -
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th and 12th Grades
Adult Ed
4th Choice
- None -
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th and 12th Grades
Adult Ed
5th Choice
- None -
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th and 12th Grades
Adult Ed
Biography
*
Please provide a short biography highlighting your educational background, qualifications, and any professional development in Arizona’s College and Career Ready Standards, Alternate Assessment, and English Language Proficiency Standards (if applicable).
Leave this field blank
Submit