AMERICAN BOARD FOR CERTIFICATION OF TEACHER EXCELLENCE (ABCTE) EXPERIENCE LOG
SECTION I: TO BE COMPLETED BY APPLICANT.
VERIFICATION OF CONTACT HOURS
1.Sixty (60) contact hours as a substitute teacher in a public school or accredited nonpublic school classroom, of which at least forty-five (45) must be teaching;
2.Sixty (60) contact hours as a substitute teacher in a public school or accredited nonpublic school, with at least thirty (30) consecutive hours in the same classroom;
3.Sixty (60) contact hours of teaching as a paraprofessional; or
4.Elementary Education applicants: Ninety (90) contact hours as a substitute teacher or paraprofessional in a public school or accredited nonpublic school classroom, of which at least thirty (30) must be teaching in an elementary classroom.
Current Name (Last, First, Middle Initial)
SECTION II: TO BE COMPLETED BY APPLICANT AND/OR ADMINISTRATOR
|
DATE |
CLASSROOM/NAME OF |
# OF HOURS/PERIODS |
# OF HOURS/PERIODS |
ADMINISTRATOR APPROVAL |
|
TEACHER |
OBSERVING |
|
LEAD TEACHING |
SIGNATURE |
|
|
|
|
|
|
TOTAL NUMBER OF HOURS:
SECTION III: TO BE COMPLETED BY SCHOOL SYSTEM
NAME OF SCHOOL SYSTEM
ADMINISTRATOR'S NAME (PRINT OR TYPE)
ADMINISTRATOR'S SIGNATURE
It is the policy of the Missouri Department of Elementary and Secondary Education not to discriminate on the basis of race, color, religion, gender, national origin, age, or disability in its programs or employment practices as required by Title VI and VII of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975 and Title II of the Americans with Disabilities Act of 1990. Inquiries related to Department programs and to the location of services, activities, and facilities that are accessible by persons with disabilities may be directed to the Jefferson State Office Building, Office of the General Counsel, Coordinator–Civil Rights Compliance (Title VI/Title IX/504/ADA/Age Act), 205 Jefferson Street, P.O. Box 480, Jefferson City, MO 65102-0480; telephone number (573) 526-4757 or TTY (800) 735-2966, fax (573) 522-4883, email civilrights@dese.mo.gov.
PLEASE RETURN THIS FORM TO THE APPLICANT.
THIS FORM MAY BE DUPLICATED FOR ADDITIONAL EMPLOYERS.
ORIGINAL SIGNATURE REQUIRED - NO FAXES OR PHOTOCOPIES.
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October 2014