Schuylkill County Guest Teacher Program

RenewalApplication Form 2018/2019

Schuylkill Intermediate Unit 29

PO Box 130, 17 Maple Avenue, Mar Lin, PA 17951

Phone 570.544.9131

The public schools of Schuylkill County and Schuylkill IU 29 do not discriminate against any persons in employment, educational programs or activities based on race, color, sex, creed, religion, age, disability, national origin, marital status or because a person is a disabled veteran or a veteran of the Vietnam era. This policy extends to all other legally protected classifications and is published in accordance with state and federal laws including Title IX of the Education Amendments of 1972 and Sections 503 and 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act.

Contact Information
(Please Print Legibly)
Last Name / First Name / Middle Name / Date
Street Address / City / State / Zip
Social Security # / Home Phone # / Cell Phone # / Email Address
College Major – B.S. Degree / Special Skills or Licenses
Preferences
All Districts chosen below may differ from what Source4Teachers allows.
SCHOOL DISTRICTS / BlueMountain
Mahanoy Area
Minersville / North Schuylkill
PineGrove
Pottsville / Saint Clair
Schuylkill Haven
Shenandoah Valley / Tamaqua
Tri-Valley
WilliamsValley
LEVEL(S) / Elementary / Middle / High
IU 29 PROGRAMS / Maple Avenue Campus
Special Education
Autistic Support
Emotional Support
Like Skills Support
Multi-Handicap
Physical Support/Vision
Schuylkill Learning Academy
Alternative Education
Day Treatment / Early Intervention
Frackville – STC North Campus
Maple Avenue Campus
Schuylkill Haven Elementary
Tamaqua Area Middle
Pine Grove Elementary
Pre-K
Maple Avenue Campus
Williams Valley Elementary
Pine GroveElementary
Schuylkill Technology Center
North Campus – Frackville
South Campus – Mar Lin

Schuylkill Intermediate Unit 29 is asking you to provide information that includes private and/or confidential information under state and federal law. We are asking for this information in order to process your application.

You are not legally required to provide the information Schuylkill Intermediate Unit 29 is requesting; however, we may not be able to effectively process your application if you do not provide sufficient information. Unless you consent to further release of private information, access to this information will be limited to school officials, including faculty who have legitimate educational interests in the information.

Signature / Date
IU29 OFFICE USE ONLY:
$5.00 (Made payable to Schuylkill IU 29) Check/MO # ______Dated ______
 / PDE 338-G /  / Act 24 Arrest/Conviction Report
 / TIMS Application
 / Emergency Permit Obtained / Date: ______/ School Year: ______

Updated 6/7/17