/ Riverside County Office of Education
Attn: Diana Ceja
Instructional Services
P.O. Box 868, Riverside, CA 92502-0868
Phone: (951) 826-6304 / Fax [951] 826-6937

Riverside County Seal of Multiliteracy: Assessor Application
Please type your information into the fields below and return this form to the address above by Friday, September 2, 2016.
All materials and continental breakfast and lunch will be provided. Please be sure to clear your participation with your supervisor.

Language Portfolio Scoring Event – Thursday, September 22, 2016

Time / 8:30 a.m. to 4:30 p.m. (Or until finished.) / Will you participate? o Yes o No

Riverside County Seal of Multiliteracy Student Assessment Event – Saturday, October 8, 2016

Time / 8:30 a.m. to 4:30 p.m. (Or until finished.) / Will you participate? o Yes o No

On-Demand Writing Scoring Event – Thursday, October 27, 2016

Time / 8:30 a.m. to 4:30 p.m. (Or until finished.) / Will you participate? o Yes o No

Contact Information

Name:
Work Phone:
Address: / Cell Phone:
City, Zip Code: / Work E-Mail:
District: / Site/Department:

What language(s) can you assess?

o Arabic / o Farsi / o Hindi / o Other
o Armenian / o French / o Mandarin Chinese / o Other
o Assyrian / o German / o Portuguese / o Other
o English / o Hebrew / o Spanish / o Other

Language Assessment: Please tell us about the language you will be assessing.

Are you a native speaker of the language? / o Yes o No
Please tell us about your educational background in the language you will be assessing.
o Advanced Degree / o College Degree / o Some College
o High School / o Received Education Abroad / o BCLAD Authorization
Other:
Do you have experience teaching this language and at what level? / o Yes o No Please explain:
Have you ever been trained or served as a translator? / o Yes o No Please explain:
How often do you use the language you will be assessing?
o Daily / o Weekly / o A few times a month. / o Once in a while. / o I haven’t used it in a long time.
On a scale of 1 to 10, with 1 being low and 10 being high, please rate your ability to assess a student's proficiency level in listening, speaking, reading, and writing in the language you will be assessing.
Listening: / Speaking: / Reading: / Writing
Additional information about your acquisition, use, or expertise in the language(s) you will be assessing: