INSTRUCTIONAL FACULTY APPLICATION 2020-21 To apply for an Instructional Faculty position in the Intern Credentialing and Added Authorization Program (iCAAP), applicants must complete this form, be recommended by their current Principal/Supervisor, and meet the following criteria:• Three or more years of successful classroom experience.• Experience in developing and delivering Professional Development (PD) and/or College-Level Courses (CLC) for adult learners.• Strong knowledge and experience in the implementation of District Initiatives.Employment as Instructional Faculty is based upon programs needs. If you have questions regarding the Instructional Faculty Application Process, please email iCAAP@lausd.net or call 213-241-5466. Question Title * 1. First Name (indicated on your Credential). Question Title * 2. Last Name (indicated on your Credential). Question Title * 3. Middle Name. Question Title * 4. Personal Information. Street Address. City / Town. ZIP / Postal Code. Mobile Phone. Question Title * 5. What Teaching Credential(s) do you hold? Check all that apply. Multiple Subject Clear. Single Subject Clear. Mild Moderate Disability Specialist Clear. Moderate Severe Disability Specialist Clear. Autism Spectrum Disorders Added Authorizations. Early Childhood Special Education Credential. Early Childhood Special Education Added Authorization. Administrative Services Credential Preliminary. Administrative Services Credential Clear. Pupil Personnel Services Credential. Certificate of Eligibility Administrative Services Credential. Other CTC-verified current Education Credentials (e.g. Career Technical Education Credential, National Board Certification, etc). Question Title * 6. Grade levels taught? Preschool Kindergarten 1st 2nd 3rd 4th 5th Middle School (6th-8th) High School (9th-12th) Other Question Title * 7. Beginning with the most recent, list the College/University and Degree attained. College/University, Degree (1) College/University, Degree (2) College/University, Degree (3) College/University, Degree (4) Question Title * 8. Professional Information. Current Position/Title. * Location Name. Location Code. * Education Service Center. Employee Number. Email Address (LAUSD). * Work Phone. * Question Title * 9. List all Professional Organizations in which you are currently involved, along with your role. Organization, Role (1) Organization, Role (2) Organization, Role (3) Organization, Role (4) Question Title * 10. List the most current Professional Development (PD) and/or College-Level Courses (CLC) that you have delivered within the last two years, beginning with the most recent PD/CLC. Indicate for each PD/CLC (a) Topic, (b) Audience, (c) Date(s) and (d) Supervising Administrator. PD/CLC (1) PD/CLC (2) PD/CLC (3) PD/CLC (4) Question Title * 11. List the most relevant Awards/Honors you have received, beginning with the most recent. Indicate for each the (a) Award/Honor and (b) Organization. Award/Honor, Organization (1) Award/Honor, Organization (2) Award/Honor, Organization (3) Award/Honor, Organization (4) Question Title * 12. Are you currently an LAUSD Lead Mentor or have you previously been a Lead Mentor? I am currently a Mentor. I have previously been a Mentor. I have never been a Mentor. Question Title * 13. Are you interested in applying to be a Mentor this year 2020-2021? Yes. No. Question Title * 14. Who referred you to the DI Program? Please list all applicable personnel. Question Title * 15. Have you ever received a Notice of Unsatisfactory Service/Act or a Below Standard Evaluation? Yes. No. Comments Question Title * 16. Provide two references, including your Principal/Supervisor. PRINCIPAL/SUPERVISOR: Name, Email, Phone OTHER: Name, Title, Email, Phone Question Title * 17. Your Supervisor Endorsement Statement is required to complete your application. Click here to download, print out the form and obtain the required signature. Scan the signed document. Email the signed document and your current resume to iCAAP@lausd.net. Your application will be reviewed once it is received. I will email the signed Supervisor Endorsement Statement and my current resume to iCAAP@lausd.net within one week of submitting this Application. Question Title * 18. I certify that all of the information in this application is true and correct. I understand that the District Intern Program will verify this information. I acknowledge that some of the ratings and results of my performance may be confidential. I agree. I do not agree. Digital Signature: type your full name below. Done!