Special Education Summer School Application 2019
Note: the date and time of your application will be recorded when you Submit the form
First Name *
Your answer
Middle Initial
Your answer
Last Name *
Your answer
Are you currently employed with Rockland BOCES? *
Name of program/school where you work
Current Position
If not Rockland BOCES, current school district you are working for:
Years with current district:
Your answer
Dates of Prior BOCES Summer Employment: (please check all that apply) *
First Choice of Position Applying For (you possess the certification/licensure) *
If you possess an additional certification/licensure and would like to apply for a second choice position, please indicate
Do you only want to substitute by calling into the registry when you are available?
If you are a related service professional, do you want to work full time?
If you are a Speech Therapist, Occupational Therapist or Physical Therapist and answered NO to the above question, please note how many days a week
If you do not work for Rockland BOCES during the school year and would like to be appointed as a substitute:
Please enter your phone number
Your answer
Please Enter Your eMail Address *
Your answer
Enter the last 4 digits of your Social Security # *
Your answer
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