West Virginia Department of Education Special Education Technology Integration Specialist (SE-TIS) Application Directions: Type responses into the form, print and mail it with assurance agreements to: WVDE, 1900 Kanawha Blvd. East, Building 6, Room 304, Charleston, WV 25305 Attention: Valerie Wilson Or scan and email to vwilson@k12.wv.us. Due April 25, 2016. Name Email Current Teaching Position Home Phone Mobile Address County/District School School Address School Phone Principal Principal’s email Years of Teaching Experience Do you have Internet access at home? Are you willing to participate in a monthly online professional learning community? List your certifications and/or endorsements List resources that you currently use when integrating technology into your curriculum. Describe how your deeper knowledge of technology integration acquired from the SE-TIS program will increase student achievement of all students in your classroom or school. 1 How will your interaction with other staff at your school change as a result of participation in the SE-TIS program? 2