District Name: School Name

District Name: School Name

All basic elementary teachers and secondary core content teachers need to be Highly Qualified (HQ). All core content teachers that receive their salaries through ESEA funds [e.g., Title I-A teacher, teacher through Title IIA class size reduction (CSR)] must be Highly Qualified at time of hire or assignment. Extensions cannot be provided for Title I and CSR teachers and plans will not be accepted for those assignments.

District Name: School Name:

Teacher Name: Teaching Assignment:

Check Current Licensure (Copy information from TSPC license, *licenses do not meet HQT requirements):

InitialBasicEmergency License* Other

Initial IStandardRestricted Transitional*

Initial IIContinuingLimited License*

Date of License expiration: Click here to enter a date.

The educator must demonstratebasic elementary or secondary core academic subject matter competency for the following assignment(s):

Please Check the Area(s) of Highly Qualified Subject(s) Needed:

Elementary Education (K-6) Reading Specialist (K-12)

English/Language Arts (7-12)Mathematics (7-12)

Social Studies (7-12) :Science (7-12): Foreign Language:

History General Science (Integrated Science)French

Civics/GovernmentBiologyGerman

EconomicsChemistrySpanish

GeographyPhysics

ArtMusic

Please indicate the action(s) the educator will pursue by the end of the current school year in order to demonstrate highly qualified status. Failure to secure proper licensure and/or endorsement by the end of the school year will impact the HQT status of both the school and the district. Districts must take appropriate actions to resolve this HQT discrepancy.

ORELA (NES) Elementary Education Test(sub-tests I and II) in the elementary setting (K-6)

( Available NES tests: )

ETS (Praxis) for remedial reading (K-12)

( Available ETS tests: )

ORELA or ETS (Praxis) for subject specific content in the secondary setting (7-12)

( Available NES tests: )

( Available ETS tests: )

Completion of Educational Preparation Program resulting in a highly qualified license.

Other

Test Code:DescriptionTest DateRegistration DateScore Date

MM/DD/YYMM/DD/YYMM/DD/YY

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//////Please attach supporting documentation (i.e. copy of test registration)

Please include the following resources to facilitate the attainment of HQ status for the teacher mentioned above. Include the name of the district personnel responsible for oversight of the activity, resources available, and projected completion date (no later than the last day of school for current school year).

Person Responsible / Resources Available
(fund source and amounts) / Completion Date

The LEA understands that the Oregon Department of Education will provide oversight and monitoring for implementation of LEA and teacher plans for ensuring that all core academic subject teachers meet the highly qualified requirement.

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LEA Authorized Signature DateTeacher Signature Date

Oregon Department of Education 2012