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Hayward USD |  E  4112.2  Personnel

Certification   

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FORMS

Attached are the forms for petitioning the Committee on Assignments for assigning individuals to teach outside the area of authorization of their credential. In accordance with the changes in AB1124, the process now focuses on assigning credential holders to departmentalized subjects K-12 or elective courses K-12. The attached forms are to be used for this purpose. It is important that these forms be filled out in as much detail as possible.

The following distinctions should be kept in mind for each of these categories:

DEPARTMENTALIZED SUBJECTS (Education Code 44258.3)

* Requires approval by the Board of Education

* Requires subject matters specialists verification of competency

* Must be with teacher consent

* Notification of exclusive representative of the certificated employees union

* May be extended by Board approval

* Applies to all subjects taught in a departmentalized setting

ELECTIVE COURSES (Education Code 44258.7 (c) & (d)

* Use for teachers with special skills or preparation

* Must be a full-time credentialed teacher

* For courses other than English, Math, Science, or Social Sciences (core academic subjects)

* Does not apply to clearly elective courses within the academic subjects

* Is good for one year

* May be extended by the Committee On Assignment with teacher consent

Exhibit HAYWARD UNIFIED SCHOOL DISTRICT

version: October 9, 2013 Hayward, California

___________________________________________________________________________

Exhibit 2

4112.2

CERTIFICATION

HAYWARD UNIFIED SCHOOL DISTRICT

COMMITTEE ON ASSIGNMENTS

DIRECTIONS FOR PETITION TO TEACH

DEPARTMENTALIZED SUBJECTS

The following directions and the attached materials are for the purpose of petitioning by a teacher and site administrator for verification of adequate knowledge to teach designated subjects in a departmentalized setting in kindergarten and any grades 1-12 in accordance with the Education Code 44258.3.

STEP 1: Review Board Policy and Administrative Regulations for Policy

STEP 2: Complete Petition to Teach Departmentalized Subjects Form

STEP 3: Prepare Additional Criteria Documentation

STEP 4: Obtain Site Administrator Recommendation

STEP 5: Obtain Subject Matter Specialist Recommendation

STEP 6: Notify exclusive representative of the certificated employees union

STEP 7: Sign and have Site Administrator Sign Petition

STEP 8: Complete Teacher Consent Form

STEP 9: Submit all Materials to the Personnel Department When Completed

Questions regarding the process of petitioning to teach departmentalized subjects should be directed to the Personnel Department.

Exhibit HAYWARD UNIFIED SCHOOL DISTRICT

version: October 9, 2013 Hayward, California

___________________________________________________________________________Exhibit 3

4112.2

CERTIFICATION

HAYWARD UNIFIED SCHOOL DISTRICT

COMMITTEE ON ASSIGNMENTS

PETITION TO TEACH DEPARTMENTALIZED SUBJECTS

This form is for use by a teacher holding a credential and a site administrator to request verification of adequate knowledge to teach designated subjects in a departmentalized setting in kindergarten or any of grades 1-12 in accordance with Education Code 44258.3.

SUBMIT THIS PETITION TO THE PERSONNEL DEPARTMENT

Teacher: ________________________________________ SSN: ___________________

School:

Subject(s) Being Requested:

Verification being requested:( ) ( ) Approval with professional growth/support plan

Briefly state why you feel you have adequate knowledge to teach the requested subject(s).

The following material must be submitted on the attached forms.

* Subject matter specialist recommendation

* Verification of knowledge of course of study and state framework(s)

* Recommendation of site administrator

* Support resources requested by teacher (attach if any)

Check the additional criteria upon which this petition is based. Attach appropriate evidence for each criteria checked.

[ ] College coursework an/or certificate of competence

[ ] Relevant practical on-the-job experience/previous teaching in subject area

[ ] Relevant volunteer experience

[ ] Subject matter examination

[ ] Demonstrated competency in subject to be taught

[ ] Portfolio related to subject(s)

[ ] Relevant professional growth activities/experience

[ ] Other subject matter specialist or expert recommendations

[ ] Other appropriate information (specify)

________________________

Teacher Signature Administrator Signature Date

Exhibit HAYWARD UNIFIED SCHOOL DISTRICT

version: October 9, 2013 Hayward, California

___________________________________________________________________________

Exhibit 4

4112.2

CERTIFICATION

HAYWARD UNIFIED SCHOOL DISTRICT

COMMITTEE ON ASSIGNMENTS

PETITION TO TEACH DEPARTMENTALIZED SUBJECTS

This form is to be used subject matter specialists when recommending that a teacher possesses adequate knowledge to teach a designated subject in a departmentalized setting in Kindergarten or any of grades 1 through 12 in accordance with Education Code 44258.3.

SUBJECT MATTER SPECIALIST RECOMMENDATION

Teacher: SSN:

Subject(s) Being Requested:

Specialist:

Based upon an interview and/or clinical observation of the teacher and a review of the submitted evidence in support of the request, my assessment of the petitioner's adequacy of knowledge of the subject matter within the appropriate state framework and the district course of student is as follows: (Attach additional pages if necessary.)

SUBJECT MATTER

STATE FRAMEWORK (S)

DISTRICT COURSE OF STUDY

___________________________________________________________________________

Signature of Specialist Date

Exhibit HAYWARD UNIFIED SCHOOL DISTRICT

version: October 9, 2013 Hayward, California

___________________________________________________________________________

Exhibit 5

4112.2

CERTIFICATION

HAYWARD UNIFIED SCHOOL DISTRICT

COMMITTEE ON ASSIGNMENTS

PETITION TO TEACH DEPARTMENTALIZED SUBJECTS

This form is to be used by a site administrator to recommend that a teacher possesses adequate knowledge to teach a designated subject in a departmentalized setting in Kindergarten or any of grades 1 through 12 in accordance with Education Code 44258.3."

SITE ADMINISTRATOR RECOMMENDATION

Teacher: SSN:

Subject(s) Being Requested:

Site Administrator::

Based upon my knowledge of the petitioner and a review of evidence received, the following is my assessment of the petitioner's adequacy of knowledge in the specified subject(s).

__________________________________________ __________________

Signature of Administrator Date

Exhibit HAYWARD UNIFIED SCHOOL DISTRICT

version: October 9, 2013 Hayward, California

__________________________________________________________________________

Exhibit 6

4112.2

CERTIFICATION

HAYWARD UNIFIED SCHOOL DISTRICT

COMMITTEE ON ASSIGNMENTS

TEACHER CONSENT FORM

PETITION TO TEACH DEPARTMENTALIZED SUBJECTS

In accordance with Board Policy, I have petitioned to request verification of adequate knowledge to teach designated subjects in a departmentalized setting in accordance with Education Code 44258.3.

Therefore, I consent to an assignment in the subject(s) approved by the Committee on Assignments and I agree to any Professional Growth Plan Requirements designated by the Committee on Assignments. I have also identified the support resources I feel are necessary for me to assume this assignment.

This consent is for the school year.

________________________________ _______________

Teachers Signature Date

Exhibit HAYWARD UNIFIED SCHOOL DISTRICT

version: October 9, 2013 Hayward, California

___________________________________________________________________________

Exhibit 7

4112.2

CERTIFICATION

HAYWARD UNIFIED SCHOOL DISTRICT

COMMITTEE ON ASSIGNMENTS

DIRECTIONS FOR PETITION TO TEACH ELECTIVE COURSES

The following directions and the attached materials are for the purpose of petitioning by a teacher with special skills or preparation and the site administrator to teach an elective course(s) in the area of specified skills or preparation in kindergarten and any of grades 1 through 12 in accordance with Education Code Section 44258.7 (c) & (d).

STEP 1: Review Board Policy and Administrative Regulations.

STEP 2: Complete Petition to Teach Elective Course(s)

STEP 3: Prepare Rationale Form for Committee on Assignments

STEP 4: Prepare Additional Information, if any

STEP 5: Obtain Site Administrator Recommendation and Rationale on Petition

STEP 6: Sign and have Site Administrator Sign Petition

STEP 7: Complete Teacher Consent Form

STEP 8: Submit all Materials to the Personnel Department when completed

Questions regarding the process of petitioning to teach elective courses should be directed to the Personnel Department.

Exhibit HAYWARD UNIFIED SCHOOL DISTRICT

version: October 9, 2013 Hayward, California

___________________________________________________________________________

Exhibit 8

4112.2

CERTIFICATION

HAYWARD UNIFIED SCHOOL DISTRICT

COMMITTEE ON ASSIGNMENTS

PETITION TO TEACH ELECTIVE COURSES

This form is for use by a teacher and site administrator to request to teach an elective course outside of current credential authorization (course other than English, Mathematics, Science, or Social Studies). Please review Board Policy.

SUBMIT THIS FORM TO THE PERSONNEL DEPARTMENT

Teacher: SSN:

School:

Course(s) Being Requested:

_______________________________ __________________________

Check all the criteria upon which this request is based.

[ ] College course work and/or certificate of competence

[ ] Relevant practical on-the-job experience

[ ] Relevant volunteer experience

[ ] Relevant/related experience in a specific subject area or area of interest

[ ] Relevant professional growth activities/experience

[ ] Previous successful teaching experience in the specific area

[ ] Demonstrated competency in teaching strategies and techniques

[ ] Demonstrated competency in subject to be taught

[ ] Other appropriate information not on the rationale form (specify and attach)

_____________________________ ___________________

Teachers Signature Date

RECOMMENDATION AND RATIONALE OF SITE ADMINISTRATOR:

Briefly state your rationale for submitting this request (attach separate page)

_____________________________ ____________________

Site Administrator Signature Date

Exhibit HAYWARD UNIFIED SCHOOL DISTRICT

version: October 9, 2013 Hayward, California

___________________________________________________________________________

Exhibit 9

4112.2

CERTIFICATION

HAYWARD UNIFIED SCHOOL DISTRICT

COMMITTEE ON ASSIGNMENTS

RATIONALE FOR COMMITTEE ON ASSIGNMENTS REQUEST

Teacher's Name___________________________

Provide a complete report of activities and data related to each of the following criteria.

[ ]College coursework and/or certificate of competence:

[ ]Relevant practical on-the-job experience:

[ ]Relevant volunteer experience:

[ ]Relevant/related experience in a specific subject area or area of interest:

[ ]Relevant professional grown activities/experiences:

Teacher's name_______________________

[ ]Previous successful teaching experience in the specific areas:

[ ]Demonstrated competency in teaching strategies and techniques:

[ ]Demonstrated competency in subject to be taught:

[ ]Other appropriate information:

Exhibit HAYWARD UNIFIED SCHOOL DISTRICT

version: October 9, 2013 Hayward, California

___________________________________________________________________________Exhibit 10

4112.2

CERTIFICATION

TEACHER CONSENT FORM PETITION TO TEACH

ELECTIVE COURSES

In accordance with Board Policy, I have petitioned to teach an elective course(s) in an area of specialist skills or preparation in accordance with Education Code 44258.7 (c) & (d).

Therefore, I consent to an assignment in the course(s) approved by the Committee on Assignments.

This consent is for the ______________________ school year.

________________________________ ___________________

Teacher signature Date

Exhibit HAYWARD UNIFIED SCHOOL DISTRICT

version: October 9, 2013 Hayward, California

__________________________________________________________________________Exhibit 11

4112.2

CERTIFICATION

SCHOOL DISTRICT PLAN

This is to certify the establishment of HAYWARD UNIFIED SCHOOL DISTRICT'S committee on Assignment in accordance with the provision of Education code 44258.3(a) & (b) and 44258.7 (c) & (d).

_____________________________________ ____________________

District Superintendent Date

_____________________________________ ____________________

District Contact Person relative to the District's Title

Plan in accordance with Education code Sections

44258.3 and 44258.7© & (d).

Effective date of establishment of committee on assignment:

____________________________________

Submit this Form to Personnel Administrator, County Office of Education

Exhibit

adopted: July 31, 2002 HAYWARD UNIFIED SCHOOL DISTRICT

revised: October 9, 2013 Hayward, CA