2020 ESY Certified Application

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Email *

Contact Information

Full Name (First, middle and last are required) *

Phone Number *

Home Address

Licensure and Training Information

1. Are you a current regular employee (non-substitute) in Dublin? *

Yes

2. Have you substituted in Dublin this school year? *

Yes

N/A

Have you worked Dublin ESY Program in previous years? *

Yes

3. Licensure/Certification area (s) valid through 07/19/2020 *

If not current, expected date when valid:

YYYY

4. If not selected for a regular Summer School position, would you be interested in being a Summer School substitute? *

Yes

5. Please describe any additional training that you have. (e.g. OG, AIMSweb, Math-u-see, etc.)

Current Position

Current District and Building

Current Subject

Current Grade

Beginning Date (Month/Year)

Current Principal

Current Principal Phone Number

Relevant Experiences (for Non-Dublin Employees only)

Previous District and Building

Previous Subject

Previous Grade

Beginning Date (Month/Year)

Ending Date (Month/Year)

Previous Principal

Previous Principal Phone Number

ESY Programming Available

Please check the ESY Program(s) that you are interested in working with this summer.

Pre-School/Elementary/Multi-Sensory Reading Times and Dates:
Orientation: May 28th, 2020 from 12:00-2:00pm at Bailey Elementary (subject to change)
ESY Dates: June 9-11, June 16-18, June 23-25, and July 7-9
ESY Staff Times: 8:00-11:30 am

Middle/High School/Multi-Sensory Reading Times and Dates:
Orientation: May 28th, 2020 from 8:00-10:00am at Scioto High School (subject to change)
ESY Dates: June 9-11, June 16-18, June 23-25, and July 7-9
ESY Staff Times: 7:45-11:15am

I am interested in working: *

Early Childhood Program: Early Childhood Intervention Specialist (certification required): This position has a focus on language arts and math improvement. Communication and socialization programs will be embedded in all classes.

Elementary ESY at Bailey Elementary: Intervention Specialist (certification required): This position has a focus on language arts and math improvement. Communication and socialization programs will be embedded in all classes.

Middle/High School ESY at Scioto High School: Intervention Specialist (certification required): This position has a focus on language arts and math improvement. Communication and socialization programs will be embedded in all classes.

Multi-Sensory Reading (additional training required): Teacher must have training in multi-sensory reading approaches (e.g. Orton-Gillingham, Wilson, etc.).

Speech and Language Pathologist: Therapist will be consulting and collaborating with teachers to ensure students will receive appropriate support and services within the natural setting of summer program classes.

Nurses: Nurses will communicate important medical concerns with ESY staff and support student medical needs throughout the summer program day.

Other:

Required

A copy of your responses will be emailed to the address you provided.

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