OFFICE OF SUPERINTENDENT OF PUBLIC INSTRUCTION
Title II Part A
Old Capitol Building
PO BOX 47200
Olympia WA 98504-7200
(360) 725-6340 TTY (360) 664-3631
PARAEDUCATOR PORTFOLIO ASSESSMENT
COVERSHEET
FULL LEGAL NAME (LAST, FIRST, MIDDLE, FORMER NAME)
TELEPHONE (HOME)
ADDRESS (STREET/PO BOX, CITY, STATE, ZIP CODE)
TELEPHONE (WORK)
E-MAIL
SCHOOL DISTRICT NAME
SCHOOL DISTRICT ADDRESS
SCHOOL BUILDING NAME
SCHOOL BUILDING ADDRESS
Statement of Authenticity
The material contained in this portfolio is my work. For confidentiality purposes, any names of children have been deleted
from student work and last names are not included in the Record of Experience.
Paraeducator’s Name:
(print name)
Paraeducator’s Signature:
Date:
FORM SPI 1581 Cover Sheet (8/04)