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Verification of a Highly Qualified
Out-of-State HOUSSE Plan
Fill in the information above the broken line. Please print or type.
last name
first name
middle name
maiden name
street address
city
state
zip code
social security number
date of birth (month,day,year)
To The State Education Agency or School District NCLB Officer:
Please complete the information below that applies to the above-named Florida teacher and
return the form to the Florida School District Certification Office as indicated below.
The applicant is highly qualified in _________________________________________________
[subject area(s) & level(s)]
based on meeting the state’s High Objective Uniform State Standard of Evaluation (HOUSSE)
requirement for that subject area(s) prior to the 2006-2007 school year.
Verifying Officer & Title (please print)
Signature
State
Date
RETURN FORM TO:
Florida School District Certification Officer
School District
Address
City, State, Zip Code