Application for 2018-2020 DTiR TermDeadline to submit: 5:00 pm – February 28, 2018

Applicant Name: Last First Middle Initial

Mailing Address: No. and Street City State Zip

District: School:

Phone: School Phone:

E-Mail: Current Teaching

Assignment:

Total number of years of classroom teaching: Years

Total number of years of classroom teaching in this district: Years

CLAD or Appropriate English Learner Authorization: Yes No

B/CLAD: Yes No

CALIFORNIA CREDENTIALS HELD

EARNED DEGREES (Abbreviate as needed)Name of Institution Location Major/Minor Earned Degree Date Received

CONTINUING EDUCATION

REFERENCES (List three persons we may contact who know your professional work.)Name Position Telephone

SIGNATURES

Applicant Signature Date

I support this application going forward:

Principal Signature Date

Rev. 11/2017 pg. 1

Application Addendum

Teaching Areas of Expertise

Applicant Name:

Distinguished Teachers (DTiRs) teach the same teacher credential classes as the regular School of Education faculty members. Please be aware that the CSUSM School of Education credentials secondary teachers in English, Mathematics, Science, Social Science, Spanish and Physical Education. Any other areas of authorization are handled elsewhere in the university or not granted by CSUSM.

Please mark the areas below which you feel you are qualified to teach based on educational background, teaching experience, and/or other areas of expertise.

For further information on teacher credential courses and graduate programs (program descriptions, course syllabi, etc.), please consult the School of Education website: http://www.csusm.edu/soe/index.html .

Mark ONLY the areas you feel qualified to teach:

Instructional Area Very Qualified

QualifiedLeast

QualifiedTeaching and Learning in Elementary Schools (EDMS 511 & 512):General teaching methods, lesson/unit planning, classroom management, etc.Teaching and Learning in Middle Schools (EDMI 511 & 512):General teaching methods, lesson/unit planning, classroom management, etc.Teaching and Learning in High Schools (EDSS 511, 530, 531, 541):General teaching methods, lesson/unit planning, classroom management, etc.Introduction to teaching as a Profession (EDUC 350):Philosophical, historical, sociological foundations of educationEducation Technology (EDUC 422)

Literacy/ Language Arts Education (EDMS 521/522, EDMI 521/522, EDSS 521)

Mathematics Education (EDMS 543, EDMI 543, EDSS 543)

Multicultural Education (EDUC 364)

Multilingual Education (EDMS 555, EDMI 555, EDSS 555)

Science Education (EDMS 545, EDMI 545, EDSS 545)

Social Studies Education (EDMS 544, EDMI 544, EDSS 544)

Special Education (EDMX 511, 512, 521, 543, 545, 555)

If you have earned a doctorate you are eligible to teach in the advanced certificate, Master’s, and Doctoral programs as well. Please mark the programs below in which you feel you are qualified to teach based on educational background, teaching experience, and/or other areas of expertise.

Mark ONLY the areas you feel qualified to teach:

Instructional Area Very Qualified

QualifiedLeast

Qualified

Teaching, Learning and Leadership (MA)

Educational Administration (MA and Ed. D.)

Literacy Education (MA)

Mathematics, Science, and Technology Education (MA)Schooling, Culture, and Language (MA)Multicultural/Multilingual Education Special Education (MA)

RESPONSE QUESTIONS

Please respond to the following numbered items. For all numbered items, give one or more examples of how you meet the criteria indicated. Your responses will be used in rank-ordering applicants and as a basis for inviting candidates for interview. Please respond directly and succinctly, double space, and restrict each response to one page or less. ( Note: Formatting for response boxes are set to double space at a 10 pt font. Boxes will expand. )

Rev. 11/2017 pg. 2

Response Question 11. Your present teaching position and a summary of a typical teaching day.

     

Rev. 11/2017 pg. 3

Response Question 22. Evidence of a broad repertoire of contemporary teaching strategies.

     

Rev. 11/2017 pg. 4

Response Question 33. Evidence of multiple approaches to student assessment.

     

Rev. 11/2017 pg. 5

Response Question 44. Knowledge of and experience working with diverse populations, including cultural, linguistic, and learning disabilities.

     

Rev. 11/2017 pg. 6

Response Question 55. Evidence of professional commitment (e.g. mentoring, working collegially with others, professional development).

     

Rev. 11/2017 pg. 7