FORM HSE 2006-1 (Revised: January 2006)

Alabama HOUSSE Application

Cover Page

This page must be completed and submitted with the application worksheets for the HOUSSE option selected. If the teacher applicant is currently employed or is under consideration for employment in an Alabama school system, the employing local superintendent or his/her designee must complete this page. If the teacher applicant is not currently employed or under consideration for employment, he/she may complete this page and submit the application worksheets directly to the address provided above.

APPLICATION SUBMITTED BY: / OR ______

(LEA Name) (LEA Code) (Teacher Name if Submitted by Self)

***************************************************************************************************************************************

Teacher: ______-____-______

Title (e.g., Mr. Mrs.) First Middle Maiden Last Name Social Security Number

Current Home Address:

Street/Apt/P.O. Box City State ZIP Code

1.  Certification

The teacher applicant holds at least a valid Class B Professional Educator Certificate, Alternative Baccalaureate-Level Certificate (ABC), Special Alternative Certificate, or Preliminary Certificate:

❏ Yes ❏ No If “No,” STOP. The teacher applicant is not eligible to use a HOUSSE option.

If “Yes,” list all certificate(s)/endorsement(s) held and include the valid period of years.

______

______

AND

2. Teaching Assignment(s)

The teacher applicant is assigned to a subject area(s) and grade level(s) covered by the certificate(s)/endorsement(s) listed above.

❏ Yes ❏ No If “No,” STOP. The teacher applicant is not eligible to use a HOUSSE option. If “Yes,” list current assignment(s):

Elementary □This teacher is assigned to teach one or more subjects in an Elementary (Grades K-6) school.

AND / OR

Middle/Secondary ❏ This teacher is assigned to teach one or more subjects in one or more grades in a middle/secondary school.

Block/Period / Subject / Grade Level / Block/Period / Subject / Grade Level
1 / 5
2 / 6
3 / 7
4 / 8

OR

❏ The teacher applicant is not currently employed or under consideration for employment by an Alabama public school system.


FORM HSE 2006-2 (January 2006)

Alabama Highly Qualified Teacher Application

HOUSSE Checklist Option

ELEMENTARY– SUMMARY OF POINTS

“Not new” elementary teachers seeking “highly qualified” status through the HOUSSE CHECKLIST option should complete the Elementary Checklist and this Summary of Points. The local employing school superintendent should submit the completed and signed application to the Alabama Department of Education. (Teachers who are certified in Alabama, but not currently employed or under consideration for employment by a local public school system, may submit applications directly to the Department to the address at the top of the Cover Page.) Teachers who earn 100 points meet the federal “highly qualified teacher” requirement. Review definitions, criteria, explanations, and instructions in the document Alabama High Objective Uniform State Standard of Evaluation (January 2006) (HOUSSE-2006) before completing this form.

Name: SSN:

School System: School:

Content Area for Highly Qualified Teacher Status: ELEMENTARY (This entry may not be changed.)

The employing superintendent or his/her designee must initial each measure used as verified.

POINTS DO NOT VARY BY TEACHER and should not be changed.

HOUSSE Checklist Measure / Element / Point Value / Total Points / Verification (local|state)
Advanced Certificate
(Attach Supplement EXP to Cover Page and Summary of Points) / Years of Public School Teaching Experience in Grades K-6 / 2 points for each year up to 2 yrs. / 4 points maximum
2 / 2 / 4
Class A or Class AA Certificate in ECE or EED / 96 / 96
Advanced Certificate in “Closely Related” Area + Experience (Attach Supplement EXP to Cover Page and Summary of Points) / Years of Public School Teaching Experience in Grades K-6 / 1 point for each year up to 10 yrs. / 10 points maximum
10 / 1 / 10
Class A or Class AA Certificate in area “closely related” to ECE or EED / 90 / 90
Experience + NBPTS (Attach Supplement EXP and Copy of NBPTS Certificate to Cover Page and Summary of Points) / Years of Public School Teaching Experience in Grades K-6 / 2 points for each year up to 5 yrs. / 10 points maximum
5 / 2 / 10
NBPTS Certificate in Content Area / 90 / 90
College Coursework –– English language arts / Semester Hours – Maximum 12 hrs. / 2 / 24 pts. max.
12 / 24
College Coursework –– Science / Semester Hours – Maximum 12 hrs. / 2 / 24 pts. max.
12 / 24
College Coursework –– Social Science / Semester Hours – Maximum 12 hrs. / 2 / 24 pts. max.
12 / 24
College Coursework –– Mathematics / Semester Hours – Maximum 12 hrs. / 2 / 24 pts. max.
12 / 24
Experience Teaching in Content Area / Years of Public School Teaching Experience in Grades K-6 / 2 points for each year up to 2 yrs. / 4 pts. max.
2 / 2 / 4
TOTAL POINTS / 100

I hereby certify the information contained in this application is accurate and that I, or my designee, have verified that documentation included in this application justifies the number of points shown above for each category.

______

Name of Superintendent or Designee Signature of Superintendent or Designee Date


HOUSSE CHECKLIST: ELEMENTARY – COLLEGE COURSEWORK IN CONTENT AREA (4 X 12)

Teacher Name: ______SSN: ______Content Area: ELEMENTARY

This teacher has earned at least 12 semester hours of credit in each of the following content areas:

1.  English language arts, which may include English, speech, journalism, drama/theatre, reading, writing, etc.; AND

2.  Science (not computer science or health science), which may include biology, chemistry, physics, physical science, earth and space science, geology, etc.; AND

3.  Social Science, which may include history, political science, economics, geography, sociology, anthropology, psychology, philosophy, etc.; AND

4.  Mathematics, which may include statistics, but may not include computer science.

If coursework is listed in quarter hours on the transcript, multiply the number of quarter hours by 0.67 and round to the nearest tenth to convert to semester hours. (For example, 5 quarter hours X 0.67 = 3.4 semester hours.)

Copies of official transcripts, from regionally accredited institutions of higher education, must be submitted with this checklist to verify courses listed below. Transcripts from the following colleges/universities are attached:

Name of College or University / Acronym or Brief Identifier
Example: University of Alabama at Birmingham / UAB
Content Area / College/Univ. / Course Prefix/No. / Course Title / Semester Hours
English Language Arts
TOTAL – Eng. Lang. Arts
Science
TOTAL – Science
Social Science
TOTAL – Social Science
Mathematics
TOTAL - Mathematics

3

HOUSSE Portfolio

Revised - January 2006