Yes _____ No _____ Subject Area(s) and Grade Level(s):________________________________________________ ? Has your certificate ever been suspended or revoked in this or any other state? Yes _____ No _____ ? If yes, please provide year certified and certification area: __________________________________________________________ ? 21. Have you ever been convicted of a felony or first degree misdemeanor? Yes _____ No _____ ? If yes, what charge(s)? _____________________________ _____ Yes _____ No Have you previously served on a district instructional materials committee? 23. Briefly state why you are interested in serving on this committee: _____________________________ _____ Yes _____ No I ...
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DOE Memorandums, Reports & Other Documents 
