St. Lucie County School District Request for Reimbursement for Online ESOL Courses Offered by The Center for Technology and Education or Schultz Center for Teaching and Leadership Applicant’s Name (please print clearly)_______________________________________________ Current Position___________________________ Work Location__________________________ Home Address Please check the category to which you belong. CATEGORY I Teachers (Primary Language Arts/English Teacher) require 300 hours of ESOL inservice in classes 1-5 listed below. Category II Teachers (Computer Literacy, Math, Science, Social Studies) require 60 hours of ESOL inservice in any Category III Teachers (All others not in categories I and II) require a minimum of 18 hours of ESOL inservice or any of the first five courses listed below. Category IV Guidance Counselors and Administrators require 60 hours of inservice in the course specifically designed for their area. Title Online ESOL Classes offered by C-Tech Ed or Shultz Center for Teaching & Learning Start Date End Date Have you attached verification of successful completion? Have you attached your canceled check showing payment for the class or other documentation that shows payment? 1. Methods of Teaching English to Speakers of Other Language 2. ESOL Curriculum and Materials Development 3. Cross-cultural Communications and Understanding 4. Testing and Evaluation of ESOL 5. Applied Linguistics 6. ESOL for Guidance Counselors 7. ESOL for Administrators 8. 18 hr. Empowering for Category III Teachers I certify that the information provided is correct and the courses that I have taken are required for my current position. I also understand that reimbursement may be limited by the funds available for this purpose and maximum reimbursement will be $100 for the cost of the 60 hour online class and $40 for the 18 hour class. __________________________________ Applicant’s Signature ________________________ Date Please send this form and all required documentation to the Department of Professional Development . FOR DISTRICT USE ONLY Approved by Cost Strip Date Payment Issued HRD0049 Rev. 4/11