Item 8.C.2.
World Language SMC
January 20, 2017
DRAFT
Application for Appointment to the World Language
Standards Advisory Committee
Applications must be received by March 31, 2017
The State Board of Education (SBE) is recruiting members of the World Language (WL) Standards Advisory Committee (SAC). The WL SAC will play a critical role in revising California’s WL standards for kindergarten through grade twelve in accordance with guidelines approved by the SBE.
WL SAC members include, but are not limited to, single-subject WL teachers or educators with WL supplemental authorizations and WL education faculty in university or community college.
Serving on the WL SAC represents a significant commitment of time and personal energy. Between October 2017 and March 2018, WL SAC members will participate in up to five two-day meetings in Sacramento and spend a considerable amount of time between meetings reviewing or researching portions of WL standards drafts. Travel and per diem costs are reimbursed at standard state rates; however, no stipend or substitute pay is provided.
The WL SAC meetings will be held at the California Department of Education on the following dates:
· October 19–20, 2017
· November 27–28, 2017
· February 1–2, 2018
· February 27–28, 2018
· March 20–21, 2018
Instructions:
· Answer all of the questions. An asterisk (*) denotes a required field.
· After answering all of the questions on a page, select the “Next” button.
· You must submit a résumé with your application.
· On the last page of the application, select the “Preview” button.
· On the next screen, review all of the responses, and then select the “Submit” button on the bottom of the screen.
· After you have submitted the application, save your Confirmation ID given on the next page. Select the “Print” button to obtain a hard copy. Select the “Download Application in pdf” button to download a pdf version of your application.
Personal and Professional Information
Application Information
First Name ______
Last Name ______
E-mail ______
Mailing Address ______
Mailing City ______
Mailing State ___
Mailing Zip Code ______
Business Phone (999-999-9999) ______
Home or Mobile Phone (999-999-9999) ______
Organization Representing, if any (optional): ______
Current Title/Position (select all that apply)
q K–12 Teacher
q School Principal/Administrator/Vice Principal
q District Administrator
q Special Education Administrator
q County Office of Education Administrator
q Curriculum Specialist
q College/University Faculty
q Professional Organization Representative/Staff
q Business/Industry Representative
q Community Member
q Parent/Guardian of Pre-K–12 Student
q Other
If other, please specify (Required if “Other” is selected above)
______
California Teaching Credentials (select all that apply)
q Multiple Subject Teaching Credential
q Multiple Subject Teaching Credential with Supplemental Authorization
q Single Subject Teaching Credential
q Single Subject Teaching Credential with Supplemental Authorization
q Single Subject Teaching Credential with Secondary Authorization
q Single Subject Teaching Credential with Special Secondary Authorization
q Standard Elementary Teaching Credential with Supplemental Authorization
q Not Applicable
q Other
If other, please specify (Required if “Other” is selected above)
______
K–12 Grade Level Experience (select all that apply)
q Pre-K
q K
q 1
q 2
q 3
q 4
q 5
q 6
q 7
q 8
q 9
q 10
q 11
q 12
q K–12 (all)
q Not Applicable
q Other
If other, please specify (Required if “Other” is selected above)
______
Employer Information
Employer______
Supervisor Name ______
Applicant Subject Area Expertise
WL Subject Area Experience (limit to 2,000 characters)
If you are a Pre-K–12 WL educator, indicate at which grade levels and for how many years you have taught your discipline area in a pre-K–12 environment. For WL college faculty, briefly describe your art focus and any related courses and levels taught. If you represent the WL industry, indicate your outside professional involvement in WL education.
______
Have you ever served on a committee that was engaged in standards or curriculum development or the review of instructional materials?
q Yes
q No
If yes, please specify (Required if “Yes” is selected above – limit to 2,000 characters)
______
List degrees/credentials that you have earned, including the institution(s) that granted them and the year granted, listing your highest achievement first.
Degree/Certification #1 (optional)
Degree/Certification ______
Issuing Institution ______
Year Issued ______
Degree/Certification #2 (optional)
Degree/Certification ______
Issuing Institution ______
Year Issued ______
Degree/Certification #3 (optional)
Degree/Certification ______
Issuing Institution ______
Year Issued ______
Degree/Certification #4 (optional)
Degree/Certification ______
Issuing Institution ______
Year Issued ______
Gender (optional):
o Male
o Female
o Decline to state
o Other (please specify)
Ethnicity (optional):
Please select all that apply from below:
o Hispanic/Latino
o American Indian or Alaska Native
o Asian
o Black or African American
o Native Hawaiian or Other Pacific Islander
o White
o Decline to state
o Other (please specify)
WL Education Experience and Expertise
Standards-Based Interdisciplinary Instructional Experience:
Describe a standards-based WL education lesson you have taught or developed that also supports student learning in English language arts, mathematics, or literacy with informational text. (This interdisciplinary lesson should be aligned to state-adopted standards in English language arts/literacy or mathematics, as appropriate.) Use 2,000 characters or less.
Differentiated Instruction for a Diverse Student Population:
Using the lesson described above, explain how you would differentiate instruction so that it is appropriate for students of all races, genders, sexual orientations, and ethnic and cultural backgrounds, students with disabilities, and students who are English learners. Use 2,000 characters or less.
Areas of Expertise and Leadership:
Describe how your education and experience have prepared you to serve as a member of the WL SAC. As part of your response, please describe your knowledge of and experience with CA WL Standards, your expertise in providing instruction that supports developing student assessments, and experience serving as an instructional leader. Use 2,000 characters or less.
Relationship with Publishers: Conflict of Interest Disclosure Statement
Your answers below will serve as the disclosure of certain information as required by the “Statement of Activities that are Inconsistent, Incompatible, or in Conflict with Duties of a Member of an Educational Policy Advisory Commission or a Committee or Panel Thereof,” as amended January 1978, and California Code of Regulations, Title 5, Education, Section 18600. Your answers will be the basis for an eligibility ruling in the event some activity appears to be inconsistent, incompatible, or in conflict with the duties assigned to the WL SAC.
For the questions below, “immediate family” is defined as your spouse and dependent children (California Government Code Section 82029).
Question 1:
Do you or a member of your immediate family have, or have you had, a business relationship at any time over the last 12 months with a publisher that produces instructional materials for California? If YES, list the company(-ies) that you have dealt with, and the amount (if any) of remuneration received. Use 1,000 characters or less.
Question 2:
Are you currently employed by or under contract to any person, firm, or organization which will do business with or submit instructional material to the California Department of Education (CDE)? If YES or UNCERTAIN, please explain and provide as much detail as possible, including name of firm, nature of contract, dates of contract, and compensation. Use 1,000 characters or less.
Question 3:
Have you ever been employed by or had any other kind of contractual relationship with any person, firm, or organization doing business with, or submitting instructional materials to, the CDE? If YES or UNCERTAIN, please explain and provide as much detail as possible, including name of firm, nature of contract, dates of contract, and compensation. Use 1,000 characters or less.
Question 4:
Do you expect to receive any royalty payments during your period of service on the WL SAC? If YES or UNCERTAIN, please explain and provide as much detail as possible, including name of firm, nature of contract, dates of contract, and compensation. Use 1,000 characters or less.
Question 5:
Were you or any member of your immediate family an author, contributor, or editor of (or consultant on) any textbook, other curriculum material, or project proposal that is likely to be submitted to the CDE? If YES or UNCERTAIN, please explain and provide as much detail as possible, including name of firm, nature of contract, dates of contract, and compensation. Use 1,000 characters or less.
Question 6:
Have you received compensation, do you expect to receive compensation, or do you have any other kind of contractual relationship with any organization that is either a subsidiary, parent organization, or “sister organization” of any entity which will do business with your advisory body or will submit materials to your advisory body? If YES or UNCERTAIN, please explain and provide as much detail as possible, including name of firm, nature of contract, dates of contract, and compensation. Use 1,000 characters or less.
Applicant Acknowledgement/Certification
o I understand that this application becomes public information when submitted. The answers to the questions under Relationship to Publisher: Conflict of Interest Disclosure Statement are true and correct to the best of my knowledge and belief. My supervisor and I are aware that while travel and per diem costs will be reimbursed at standard state rates, no stipend or substitute reimbursement is provided to WL SAC members. I have discussed this application with my supervisor and have received approval for release time to participate in all related activities.
Supervisor/Employer Information and Professional References
Supervisor/Employer
Please provide contact information for the individual who can authorize release time.
First Name:
Last Name:
Position Title:
Phone:
E-mail: (generates e-mail message to your employer)
When you submit your application form, a message will be automatically sent to the employer’s e-mail address you enter above.
[sent from mailto:
Dear <First Name> <Last Name>,
This message is being sent to notify you that <First Name> <Last Name>
(<e-mail address>), a member of your staff, has submitted an application to participate as a member of the World Language (WL) Standards Advisory Committee to revise California’s WL standards. If appointed by the State Board of Education, the candidate is committing to attend a sequence of meetings and to support the development of revised WL standards. Panel members will attend up to five two-day meetings at the California Department of Education in Sacramento from October 2017 to March 2018 and devote significant time outside of the meetings to review draft standards. Travel and per diem costs are reimbursed at standard state rates; however, no stipend or substitute pay is provided.
Professional References
Please provide the names and contact information for at least one and up to three professional references.
First Name:
Last Name:
Position Title:
Institution:
Street Address:
City:
State:
Zip Code:
Phone:
E-mail:
First Name:
Last Name:
Position Title:
Institution:
Street Address:
City:
State:
Zip Code:
Phone:
E-mail:
First Name:
Last Name:
Position Title:
Institution:
Street Address:
City:
State:
Zip Code:
Phone:
E-mail:
Upload a Résumé
Note: Please attach a current résumé as it relates to your educational background and experience in WL education in kindergarten through grade twelve and/or higher education. If you are a classroom teacher, include a list of the classes you are currently teaching and the grade level(s). Please limit your résumé to two or three pages, and include your name on each page. Please limit the size of the file to under 5 MB.
© California Department of Education, January 2017
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