_____ Teacher Lay Citizen _____ Supervisor of Teachers School Board Member Has this person been designated “Teacher of the Year” at any level? Yes _____ No _____ If yes, what charge(s)? Yes _____ No _____ Has your certificate ever been suspended or revoked in this or any other state? 4 _____ Teacher Lay Citizen _____ Supervisor of Teachers ______ School Board Member If you are presently a classroom teacher or teaching supervisor, please list below the subjects you are teaching/supervising and the grade level(s) at which the instruction/supervision is provided.
Allowed
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DOE Memorandums, Reports & Other Documents 
