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Please complete all information and attach a copy of your resume.
Date:_________________
Name: _______________________________________________________________ SS
#_____________
(Mr./Mrs./Ms.) (First) (Last)
School Name:
__________________________________________________________________________
Street:
________________________________________________________________________________
City: ____________________________ State: New York
Zip: _________________
School Telephone:
(____)_______________________ Fax ( )_______________________
School Email:
__________________________________________________________________________
Principal:
______________________________________________________________________________
School District:
________________________________________________________________________
Home Address:_________________________________________________________________________
City:
____________________________ State: New York Zip:
___________ County:____________
Home Telephone :
(_____)__________________ Home Email:
_______________________________
Grade Level configuration(s) for which you are qualified and certified to teach:
_____ K-1 _____2-4 _____5-6 _____7-8 _____9-12
New York State Teaching Certification (Please check all that apply)
_____ESL _____ELA _____Other (Please
Specify)_________________________
Race/Ethnicity (Check as many as apply)
_____ Black/African American
_____ Asian/Pacific Islander
American
_____ White/Caucasian
_____ Hispanic/Latino American
_____ Native American
_____ Other (Specify) ____________
Education: (Circle degree and write your field)
B.A./B.S. ____________________ M.A./M.S. ______________________ Other ___________
Experience teaching ESL or English. (Please include Number of Years, Grade, and Courses)
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
What experience have you had
with test development tasks (i.e. item writing, item review, exam
review, standard setting, and range finding?)
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Please indicate which test development tasks you would like to be considered
for:
______Range Finding
______Item Review ______Item Writing
______Passage Selection
E-mail: emscassessinfo@mail.nysed.gov
FAX: (518) 474-1989
MAIL: Office
of State Assessment-NYSESLAT
New York State
Education Department
Attention: Vanessa Lee Mercado
Room 775 EBA
Albany, New York 12234