# Personnel Development Program Data

**Collection System: Scholar/Obligee** 

**Record Form (Completed by** 

**Institution of Higher Education)** OM B Control Number: 1820 -0686 Expiration: XX/XX/XXXX **OMB Paperwork Reduction Statement** According to the Paperwork Reductio n Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 25 minutes per response, includi ng time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is required to obtain or maintain benefits ( Individuals with Disabilities Education Act of 2004 (IDEA) and its corresponding , regulations, 34 CFR Part 304 ) . Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, W ashington, DC 20210 -4537 or email ICDocketMgr@ed.gov and reference the OMB Control Number 1820 -0686 . Note: Please do not return the completed Scholar/Obligee Record Form to this address.OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 1 **Rules of Behavior for Department of Education -** **Sponsored Website** The Office of Special Education Program’s Personnel Development Program (PDP) Data Collection System ( DCS ) is an online data collection system designed to fa cilitate administration of the PDP Progra m. This system collects employme nt and contact information from participating scholar/obligees to verify the fulfillment of their service obligation and assess program performance . Verifying service obligation requires collecting personally identifying information from Institutions of Higher Education, scholars/obligees, and employers. This data collection has been authorized by the Individuals with Disabilities Education Act of 2004 (IDEA) and its corresponding requirements 34 CFR Part 304 printed in the Federal Register Volume 70 No. 57 March 25, 2005 and regulations Vol. 71 No. 107 June 5, 2006 , and the Government Performance and Results Act of 1993, section 4. Users of the DCS mu st agree to certain conditions and agree to act to insure th e accuracy and confidentiality of the information stored by the DCS . Violation of this policy will result in suspension of grantee access to the DCS . Users representing grantees agree to:

 Maintain requested grant information, including grant contact inform ation ;  Maintain DCS accounts established to collect grant, grantee and scholar/obligee information by: o Protecting account login names and passwords ; o Subm itting scholar/obligee information as requested by DCS ; o Reviewing scholar/obligee information for accuracy ; and o Protecting the confidentiality of personally identifyin g information requested by DCS . By agreeing to these Rules of Behavior, grantee representatives agree to maintain the confidentiality of this information. 

## □ **I agree to the terms.**OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 2 

# Institution of Higher Education **Scholar/Obligee Record Form**  **Instructions**

 **Required Fields** : Please complete the following questions for the scholar/obligee record. Required items are marked with an asterisk.

 **Entering Scholars** : Please note that scholars/obligees may only be entered into the DCS under one OSEP grant at a time . If a scholar/obligee is funded sequentially under multiple OSEP funded grants , please exit the scholar from the first OSEP grant and assure that the scho lar completes the Exit C ertification from that OSEP grant. Then, the scholar and grantee must submit a new P re - S cholarship Agreement under the next OSEP grant from which the scholar will receive funds. Please contact the Data Collection Center ( DCC) Help D esk for further information , if needed .  **Sy stem Timing Out**  : You will be logged out of the system after 30 minutes of inactivity. A warning message will appear after 25 minutes of inactivity.

 **Saving and Submitting Records** : To save a record for future editing or completion, click on the SAVE button. This will create a pending record. Wh en a student has completed or exited the program and all the required information has been entered, check the box in Section L. Then, click on the SUBMIT button. Wh en the record is “submitted, ” it CANNOT be edited. To edit submitted records , please contact the DCC 

### Helpdesk. Once a record is submitted for an exited or completed scholar/obligee, the schola r/obligee is given access to the database for input of employment information.

 **Scholar/oblige access to sy stem**  : Currently enrolled scholars/obligees are given access to the system when their records are submitted , if they have completed one or more academ ic years of training which makes them eligible to begin fulfilling their service obligation . 2006 Regulations: §304.30(f)(2). Records submitted for currently enrolled scholars/obligees can be edited.OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 3 **Grant A ward Number:**  **[PRE -**  **FILLED]**

**A. Identifying Inform**  **ation** ***First Name** Middle Name ***Last Name** Ma iden Name, if applicable: ***Social Security**

**Number** -- -- ***Date of Birth** ***Primary**

**E -**  **mail A ddress**  ***Verify Primary**  **E -**  **mail A ddress**  Alternative E - mail Address Verify Alternative E - mail Address * Required fields necessary to submit a record. 

## For grants aw**arded prior to FY 2012, please enter the 3 -** **digit Scholar Data Report ID: __ __ __** OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 4 **B. Contact Information Primary**  **A ddress**  ***A ddress**  ***City** ***State** ***Zip Code 1** 

***** **Home Phone**  Cell Phone (XXX) XXX

- XXXX (XXX) XXX - XXXX Secondary Address Address City State Zip Code Other Phone Fax (XXX) XXX

- XXXX (XXX) XXX - XXXX * Required fields necessary to submit a record.

1 Allow Postal Code if State = Outside the U.S.; Display Country FieldOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 5 **C .**  **Al ternate Contact** **2** 

### Information ***First Name** ***Last Name**

***** **E -**  **mail A d**  **dress** ***Verify Primary**  **E -**  **mail A ddress**  ***A ddress** 
***City** ***State** ***Zip Code**  **3**

***** **Home Phone**  Other Phone (XXX) XXX

- XXXX (XXX) XXX - XXXX * Required fields necessary to sub mit a record. **Please review and verify the information in Sections A , B, and C. Check the box below if there**  **have been no changes in the last year**  **.** [This instruction and the check box will not be displayed the first tim e a scholar/obligee record is c reated and submitted.] 

## □ **No changes necessary .** 

2 An alternate contact is an individual who will always know where the scholar is residing. 3 Allow Postal Code if State = Outside the U.S.; Display Country FieldOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 6 **D .**  **Pre -** **Scholarship Ag**  **reement** Please submit the Pre- S cholarship Agreement fo r this scholar . 

### [See attached Pre-Scholarship Agreement . ]OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 7 **E .**  **Scholar Demographic Information**  Section E only needs to be completed once. On ce the record has been submitted, you must contact DCC to edit any of these items. **1. What is this scholar’s gender?** 

o Female o Ma le **2. Is this scholar of Hispanic or Latino origin?** 

o Yes o No **3. What is this scholar’s race?**  C heck all that apply.



###  American Indian or Alaska Native 

###  Asian 

###  Black or African American 

###  Native Hawaiian or Other Pacific Islander 

###  Wh ite **4. Does this scholar have a disability** **?**

o Yes o No o Unknown **5. What is this scholar’s current age?** 

o Under 21 o 21 -29 o 30 - 39 o 40 -49 o 50 and overOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 8 **F . Training**  **and Empl oy** **ment Prior to Entry into**  **OSEP Grant Training**  Section F only needs to be completed once. Once the record has been submitted, you must contact DCC to edit any of these items.

***** **1 .**  **Check the degree(s) or certificate(s) or endorsement(s) the**  **participant he**  **ld when he/she entered this**  **OSEP grant** **- supported training**  ( check all that apply):



###  High school diploma or equivalency [If only degree, go to Question 5] 

###  Associate’s Degree 

###  Bachelor's Degree 

###  Master's Degree 

###  Educational Specialist 

###  Doctoral Degree 

###  Postdoctora l Degree 

###  State or Professional Credential/Certificate 

###  State - issued Endorsement ***2. If scholar was granted a degree/certificate/endorsement prior to entry**  **into this OSEP**  **grant -** **supported training, the area(s) was** : (check all that apply)



###  General education ( If general education only, go to question 3) 

###  Special education or related services (Select training area under 2b) 

###  Outside the field of education (If outside of the field of education only, go to question 5 )OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 9 **2b. If special education or related services i**  **s checked under 2a above, select one**  **special education and/or**  **one related services training area that best describes the focus of**  **the scholar’s degree/certificate/endorsement prior to entry into this**  **OSEP grant**  **** **supported training.** Training Area **I. Special**  **Education** Training Area **II. Related Services**   General special education, crosscategorical, generic, multi - categorical, or non - categorical  Audiology  Counseling  Educational diagnostician  General special education, mild or

moderate  Interp reter/ASL  Low incidence disabilities/multiple

disabilities/ severe disabilities  Music therapy  Nursing  Combined studies: general education

and special education  Occupational therapy  Orientation & mobility  Developmental delay  Paraprofessional  Specific learning disabilities  Physical therapy  Speech/language impairment  Rehabilitation counseling  Emotional disturbance/behavioral

disorders  School counseling  Autism  Psychology  Traumatic brain injury  Speech/language  Deafness and/or hard - of- hearing  Social work  Visual impairment and/or blindness  Therapeutic recreation  Deaf/blindness  Wo rk experience coordinator (Employment transition specialist)  Intellectual disability: mild/moderate  Intellectual di sability: severe  Other health impairment  Physical impairment/orthopedic

impairment  Adapted physical education  Assistive technology  Bilingual special education/ESL/TESOL  Early childhood/early intervention  Special educatio n for youth in

correctional facilities  Secondary t ransitionOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 10 **2c. If appropriate, select up to three additional training areas to provide more detailed**  **information about the scholar’s focus of training prior to entry into this**  **OSEP grant**  **** **supported training.**  Training Area **I. Special Education**  Training Area **II. Related Services**   General special education, crosscategorical, generic, multi - categorical, or non - categorical  Audiology  Counseling  Educational diagnostician  General special education, mild or

moderate  Interpreter/ASL  Low incidence disabilities/multiple

disabilities/ severe disabilities  Music therapy  Nursing  Combined studies: general education

and special education  Occupational therapy  Orientation & mobil ity  Developmental delay  Paraprofessional  Specific learning disabilities  Physical therapy  Speech/language impairment  Rehabilitation counseling  Emotional disturbance/behavioral

disorders  School counseling  Autism  Psychology  Traumat ic brain injury  Speech/language  Deafness and/or hard - of- hearing  Social work  Visual impairment and/or blindness  Therapeutic recreation  Deaf/blindness  Wo rk experience coordinator (Employment transition specialist)  Intellectual disability: mild/moderate  Intellectual disability: severe  Other health impairment  Physical impairment/orthopedic

impairment  Adapted physical education  Assistive technology  Bilingual special education/ESL/TESOL  Early childhood/early intervention  Special education for youth in

correctional facilities  Secondary t ransitionOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 11 **3. If**  **prior training**  **was in**  **special education,**  **other education,**  **or related**  **services, what**  **age(s) or**  **grades of**  **children was the**  **scholar trained**  **to prov**  **ide direct**  **or indirect**  **services to?**  (c heck one) o Early intervention (infants and toddlers) o Early childhood (preschool, ages 3 – 5, ages 3 – 8) o Birth through age 8 o Elementary (grades K – 6 th , K – 8 th , PreK – 6 th , PreK – 8 th ) o Middle/Jr. High school (grades 6 th

– 8 th , 7 th

– 9 th ) o High school (grades 9 th

– 12 th , 10 th

– 12 th ) o Junior/senior high combined o Grades K – 12 o Birth through young adult (birth – age 21, birth – age out) o Adolescents through post- secondary age/young adult o Post- secondary age/young adult (18 – 22 years, 18 – 25 years) o Adults with disabilities o All ages, birth through adulthood **4. Has this scholar received funding under a different OSEP training**  **grant?** o Yes (Please specify grant number _________________________) o No **5a. Ho w many** 

**credit hours did this scholar earn prior to enrollment that were accepted**  **towards completion of this OSEP grant** **- supported**  **program?**

_________________________ **5b. What is the total number of credit hours required to complete this program?**

_____________________OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 12 **6 .**  **Was the scholar employed during the academic year, prior to entry into this**  **OSEP grant**  **- s**  **upported training?** o Yes o No (Go to Section G) **7 .**  **In what state was the scholar working?** ___ ___ (State abbreviation) (Use online pull down box to select state or the outside of the country option) **8 .**  **Choose one ty pe of employ** **ment that best describes the pre**  **- entry position of this**  **scholar:** o Special education teacher o General education teacher (not special education) o Early interventionist, early childhood, or early childhood s ervice provider o Special education paraprofessional/aide o General education paraprofessional/aide (not special education) o Early intervention, early childhood special education, or early childhood

paraprofessional/aide o Related or supportive service provider i n early intervention, early childhood or

in a school setting o Related or supportive service provider in a non - school setting (e.g., child find

services ) o Administrator/C oordinator /Supervisor (including the capacity of a principal) o Instructional Specialist o Hi gher education (e.g., faculty, research assistant, practicum coordinator) (If

selected, go to question 9 and then Section G o Other, within education (please specify) o Outside the field of education (If selected, go to Section G )OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 13 **9 .**  **What age(s) or grades of children did the scholar provide direct or indirect services to**  **in this pre -** **entry position?** (Check one) o Early intervention (infants and toddlers) o Early childhood (preschool, ages 3 – 5, ages 3 – 8) o Birth through age 8 o Elementary (grades K – 6th, K – 8th, PreK – 6th, PreK – 8th) o Middle/Jr. High school (grades 6th – 8th, 7th – 9th) o High school (grades 9th – 12th, 10th – 12th) o Junior/senior high combined o Grades K – 12 o Birth through young adult (birth – age 21, birth – age out) o Adolescents through post- second ary age/young adult o Post- secondary age/young adult (18 – 22 years, 18 – 25 years) o Adults with disabilities o All ages, birth through adulthood **10 .**  **Was this scholar {highly qualified/qualified/fully**  **certified} for this position under the**  **Individuals with Di sabilities Education A** **ct ( IDEA** **) and has not had certification or**  **licensure requirements waived on an emergency , temporary**  **or provisional basis? {Highly**  **qualified/Qualified/Fully certified} for purposes of this data collection means that**  **the scholar meets t he state requirements, if there are requirements in your state, for**  **certification/licensure for this position.** o {Highly qualified/Qualified/Fully certified} o {Not highly qualified/Not qualified/Not fully certified} o This state does not have requirements for certification/licensure for this

position. [Note: If the position ( FQ8 ) is an elementary or secondary general education/special education teacher, display “highly qualified”; if the position is general education/special education paraprofessional/aide o r early intervention, early childhood or preschool paraprofessional/aide, display “qualified”; or if the position is administrator/coordinator, for related or supportive services in a school setting, or for teacher, related services, or supportive service s in early intervention, early childhood, display “fully certified.”]OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 14 **G .**  **Current Training Program Information**  ***1. Date s**  **cholar enrolled in**  **OSEP t**  **raining program**  **:** __________ (mm/yyyy)
*******2 . Check the degree(s) or certificate(s) or**  endorsement(s) the scholar is pursuing through this special education or related services **training grant:** (Check all that apply) 

###  Associate’s degree 

###  Bachelor’s degree 

###  Master’s degree 

###  Educational specialist 

###  Doctoral degree 

###  Postdoctoral degree 

###  State or professional credential /certificate 

###  State - issued endorsement 

###  Course completion only; no degree(s), certificate(s), or endorsement(s) will be awarded when the scholar completes the OSEP grant- supported training *******3 .**  **What age(s) or grades of children is the scholar training to pro vide direct or indirect**  **services to?** (Check one) o Early intervention (infants and toddlers) o Early childhood (preschool, ages 3 – 5, ages 3 – 8) o Birth through age 8 o Elem entary (grades K – 6 th , K – 8 th , PreK – 6 th , PreK – 8 th ) o Middle/Jr. High school (grades 6 th

– 8 th , 7 th

– 9 th ) o High school (grades 9 th

– 12 th , 10 th

– 12 th ) o Junior/senior high combined o Grades K – 12 o Birth through young adult (birth – age 21, birth – age out) o Adolescents through post- secondary age/yo ung adult o Post- secondary age/young adult (18 – 22 years, 18 – 25 years) 

### o All ages, birth through adulthoodOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 15 *******4 a.**  **Select one**  **special education and/or one**  **related services training area that best describes the training focus for which the scholar is enrolled.**  Training Area **I. Special Education**  Training Area **II. Related Services**   General special education, crosscategorical, generic, multi - categorical, or non - categorical  Audiology  Counseling  Educational diagnostician  General special education, mild or

moderate  Interpreter/ASL  Low inc idence disabilities/multiple

disabilities/ severe disabilities  Music therapy  Nursing  Combined studies: general education

and special education  Occupational therapy  Orientation & mobility  Developmental delay  Paraprofessional  Specific learning disabilities  Physical therapy  Speech/language impairment  Rehabilitation counseling  Emotional disturbance/behavioral

disorders  School counseling  Autism  Psychology  Traumatic brain injury  Speech/language  Deafness and/or ha rd - of- hearing  Social work  Visual impairment and/or blindness  Therapeutic recreation  Deaf/blindness  Wo rk experience coordinator (Employment transition specialist)  Intellectual disability: mild/moderate  Intellectual disability: severe  Other health impairment  Physical impairment/orthopedic

impairment  Adapted physical education  Assistive technology  Bilingual special education/ESL/TESOL  Early childhood/early intervention  Special education for youth in

corre ctional facilities  Secondary t ransition Notice to 325D (Leadership) grantees: If the special education and related services areas above are not appropriate for the training focus of your grant, please provide a brief description of the scholar’s training focus below.OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 16 **4 b.**  **If appropriate, select up to three additional training areas to provide more detailed information about the scholar’s focus of training.**  Training Area **I. Special Education**  Training Area **II. Related Services**   General speci al education, crosscategorical, generic, multi - categorical, or non - categorical  Audiology  Counseling  Educational diagnostician  General special education, mild or

moderate  Interpreter/ASL  Low incidence disabilities/multiple

disabilities/ severe disabilities  Music therapy  Nursing  Combined studies: general education

and special education  Occupational therapy  Orientation & mobility  Developmental delay  Paraprofessional  Specific learning disabilities  Physical therapy  Speech/language impairment  Rehabilitation counseling  Emotional disturbance/behavioral

disorders  School counseling  Autism  Psychology  Traumatic brain injury  Speech/language  Deafness and/or hard - of- hearing  Social work  Visual impai rment and/or blindness  Therapeutic recreation  Deaf/blindness  Wo rk experience coordinator (Employment transition specialist)  Intellectual disability: mild/moderate  Intellectual disability: severe  Other health impairment  Physical im pairment/orthopedic

impairment  Adapted physical education  Assistive technology  Bilingual special education/ESL/TESOL  Early childhood/early intervention  Special education for youth in

correctional facilities  Secondary t ransitio n **Please review and verify the information in Section G Items 1 through**  **4 .**  **Check the box below if there have been no changes in the last**  **year .**  [This instruction and the check box will not be displayed the first time a scholar/obligee record is created and submitted.] 

## □ **No changes necessary .** OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 17 **Note: Section G, Items**  **5 and**  **6 must be completed annually**  **for scholars who**  **were enrolled in the OSEP**  **- grant program during the current budget y** **ear.** ***** **5 . During**  **the current or most recent**  **grant budget y ear,**  **was thi s scholar considered by**  **your institution to be a**  **full -** **time or part -** **time scholar? Grant Fiscal Year**  Full -time scholar, even if the scholar worked full -time or part-time Part-time scholar (anything less than full -time) **[PRELOA D DA** 

**TES FY 1]** o Full -time schol ar 

### o Part-time scholar **[PRELOA D DA** 

**TES FY 2]** 

### o Full -time scholar 

### o Part-time scholar **[PRELOA D DA** 

**TES FY 3]** 

### o Full -time scholar 

### o Part-time scholar **[PRELOA D DA** 

**TES FY 4]** 

### o Full -time scholar 

### o Part-time scholar **[PRELOA D DA** 

**TES FY 5]** 

### o Full -time scholar 

### o Part-time scholar **[PRELOA D DA** 

**TES FY 6]** 

### o Full -time scholar 

### o Part-time scholar **[PRELOA D DA** 

**TES FY 7]** 

### o Full -time scholar 

### o Part-time scholar [Grantee will only be able to edit the row for the current budget year and prior years]
***** **6 . Specify** 

**the total amount of funding this scholar received directly**  **from this OSEP**   ** supported training grant during** **the current or most recent grant budget year.**  In calculating the total amount, include any training stipend funds used for tuition and fees, scholar stipends, books, travel in conjunction with training assignments, and other associated training expenses. Please enter $0 for a scholar who was enrolled in the grant program but did not receive funding during the current budget year**. Grant Fiscal Year**  **Funding A mount**  **[PRELOA D DA** 

**TES FY 1] $**  **[PRELOA D DA** 

**TES FY 2] $**  **[PRELOA D DA** 

**TES FY 3] $**  **[PRELOA D DA** 

**TES FY 4] $**  **[PRELOA D DA** 

**TES FY 5] $**  **[PRELOA D DA** 

**TES FY 6] $**  **[PRELOA D DA** 

**TES FY 7] $**  **Total $[SUM A** **BOVE]** [Grantee will only be able to edit the row for the current budget year .]OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 18 **H .**  **Employ m**  **ent Information During OSEP**  **Grant Program**
***** **1 . During**  **the current or most recent**  **grant budget y ear,**  **was this scholar employ ed?**  **Grant Fiscal Year** Employed **[PRELOA D DA** 

**TES FY 1]** o Yes 

### o No **[PRELOA D DA** 

**TES FY 2]** o Yes 

### o No **[PRELOA D DA** 

**TES FY 3]** o Yes 

### o No **[PRELOA D**  **DA**

**TES FY 4]** o Yes 

### o No **[PRELOA D DA** 

**TES FY 5]** o Yes 

### o No **[PRELOA D DA** 

**TES FY 6]** o Yes 

### o No **[PRELOA D DA** 

**TES FY 7]** o Yes 

### o No [Grantee will only be able to edit the row for the current budget year and prior years. If scholar is not employed during current budget year, g o to Section I.] **2. If y** **es, enter the average number of hours per week this scholar was employ ed:** 

_______ (Round to the nearest hour) *******3. Is this position:**  

### o Same position held before entry to this OSEP grant- supported training (Go to

Section I.) 

### o For cont inuing scholars only, same position held in previous budget year (Go to

Section I.) 

### o Different or new position (Proceed to question 4) **4. Choose**  **one ty** **pe of employ ment that best describes this scholar’s position:**  o Special education teacher o General education teacher (not special education) o Early interventionist, early childhood, or early childhood service provider o Special education paraprofessional/aide o General education paraprofessional/aide (not special education) o Early intervention, early childhood special education, or early childhood

paraprofessional/aide o Related or supportive service provider in early intervention, early childhood or

in a school setting o Related or supportive service provider in a non - school setting (e.g., child find

services ) o Administrator/C oordinator /Supervisor (including the capacity of a principal) o Instructional Specialist o Higher education (e.g., faculty, research assistant, practicum coordinator) (If

selected, go to question 5 and then Section I) o Other, within education (please specif y) o Outside the field of education (If selected, go to Section I )OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 19 **5. If the scholar is employ** **ed in education, special education or related services, what age(s) or grades of children does the scholar provide direct or indirect services to?**  (Check one) o Early intervention (infants and toddlers) o Early childhood (preschool, ages 3 – 5, ages 3 – 8) o Birth through age 8 o Elementary (grades K – 6th, K – 8th, PreK – 6th, PreK – 8th) o Middle/Jr. High school (grades 6th – 8th, 7th – 9th) o High school (grades 9th – 12t h, 10th – 12th) o Junior/senior high combined o Grades K – 12 o Birth through young adult (birth – age 21, birth – age out) o Adolescents through post- secondary age/young adult o Post- secondary age/young adult (18 – 22 years, 18 – 25 years) o All ages, birth through a dulthood **6. Is this scholar {highly qualified/qualified/fully**  **certified} for this position under IDEA ?**  **{Highly qualified/Qualified/Fully**  **certified} for purposes of this data collection means that the scholar meets the state requirements, if there are requ**  **irements in y our state, for**  **certification/licensure for this position.** o {Highly qualified/Qualified/Fully certified} o {Not highly qualified/Not qualified/Not fully certified} o This state does not have requirements for certification/licensure for this

positio n. [Note: If the position (HQ4) is an elementary or secondary general education/special education teacher, display “highly qualified”; if the position is general education/special education paraprofessional/aide or early intervention, early childhood or preschool paraprofessional/aide, display “qualified”; or if the position is administrator/coordinator, for related or supportive services in a school setting, or for teacher, related services, or supportive services in early intervention, early childhood , display “fully certified.”]OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 20 **I .**  **Scholar Status**  Please indicate the appropriate program status of the scholar/obligee below. You must complete all subquestions for the option selected. **1. Program Duration:**  Select the most appropriate option below. ○ This program is less than one academic year in duration. ○ This program is more than one academic year in duration, but the scholar/obligee has not yet completed one academic year of training. ○ This program is more than one academic year in duration and the scholar/obligee completed one academic year of training on __________ (mm/dd/yyyy). 2. * **Scholar/obligee program status:** Select the most appropriate option below. 

# ○ The scholar

/obligee is still enrolled in the program and is currently recei ving OSEP funding . 

# ○ The scholar

/obligee i s still enrolled in the program but is no longer receiving OSEP funding because:


# ○ Grant support terminated due to OSEP grant ending .

Please enter the date the OSEP grant ended: __________ (mm/dd/yyyy) (Th e date above reflects the most recent end date in the grant profile. If you edit the grant end date, you will be prompted to update the grant profile.) 

# ○ Please enter the date of scholar exit/graduation/completion, if applicable.

__________ (mm/dd/yyyy) and submit the Exit Certification (with scholar). Is it expected that the scholar will continue en rollment in another OSEP supported training to complete the scholar’s program ? 

# ○ Yes If yes, what is the grant number? ____________________

____ ( S ubmit a P re - S cholarship Agreement with the scholar fo r the new OSEP grant under which t he scholar will receive funding. ) 

# ○ No 

# ○ Don’t knowOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 21 

# ○ Other Please specify other reason scholar /obligee is no longer receiving OSEP funding but is still enrol led .

________

_________________________________________________ __ Is it expected that the scholar will be enrolled in an program supported by an OSEP grant at a future date? 

# ○ Yes 

# ○ No 

# ○ Don’t know 

# ○ The scholar

/obligee exited/graduated/completed the program Please enter the date of exit/graduation/completion, if applicable. __________ (mm/dd/yyyy)OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 22 

# ○ The scholar

/obligee exited without graduating/completing the program . Please enter the date of exit without completion :__________ (mm/dd/yyyy) Wh at are the **reason(s)** that the scholar/obligee is no longer enrolled in this program ? (Check all that apply) 

# □ Transferred to another training program in special education or related services 

# □ Transferred to another program NOT in special education or related services 

# □ Financial stress or burden 

# □ Health (physical/emotional) of self or family member 

# □ Moved 

# □ Obtained employment 

# □ Other personal reasons 

# □ Poor academic performance 

# □ Poor practicum/field - based performance Is it expected that the scholar will be enrolled in a program supported by an OSEP grant at a future date? 

# ○ Yes 

# ○ No 

# ○ Don’t knowOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 23 **J .**  **Scholar Exit Information**  ***1.What degree(s) or certificate(s) o r endorsement(s) did this scholar receive as a result**  **of completing this OSEP**  **grant -** **supported training:** 

### (Check all that apply)

 Associate’s degree 

###  Bachelor’s degree 

###  Master’s degree 

###  Educational specialist 

###  Doctoral degree 

###  Postdoctoral degree 

###  State or profess ional credential/certificate 

###  State - issued endorsementOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 24 *******2a .**  **Select one**  **special education and/or one related services training area that best describes the training focus of the degree(s) or certificate(s) or endorsements(s)**  **that this scholar received from this**  **OSEP grant**  **- supported training.**  Training Area **I. Special Education**  Training Area **II. Related Services**   General special education, crosscategorical, generic, multi - categorical, or non - categorical  Audiology  Counseling  Educational diagnostician  General special education, mild or

moderate  Interpreter/ASL  Low incidence disabilities/multiple

disabilities/ severe disabilities  Music therapy  Nursing  Combined studies: general education

and special education  Occupational thera py  Orientation & mobility  Developmental delay  Paraprofessional  Specific learning disabilities  Physical therapy  Speech/language impairment  Rehabilitation counseling  Emotional disturbance/behavioral

disorders  School counseling  Aut ism  Psychology  Traumatic brain injury  Speech/language  Deafness and/or hard - of- hearing  Social work  Visual impairment and/or blindness  Therapeutic recreation  Deaf/blindness  Wo rk experience coordinator (Employment transition specialist)  Intellectual disability: mild/moderate  Intellectual disability: severe  Other health impairment  Physical impairment/orthopedic

impairment  Adapted physical education  Assistive technology  Bilingual special education/ESL/TESOL  Early childhood/early intervention  Special education for youth in

correctional facilities  Secondary t ransition Notice to 325D (Leadership) grantees: If the special education and related services areas above are not appropriate for th e training focus of your grant, please provide a brief description of the training focus of the scholar’s degree(s) or certificate(s) or endorsements(s) below.OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 25 **2b. If appropriate, select**  **up to three additional training areas to provide more detailed**  **in formation about the scholar’s focus of training.**  Training Area **I. Special Education**  Training Area **II. Related Services**   General special education, crosscategorical, generic, multi - categorical, or non - categorical  Audiology  Counseling  Educati onal diagnostician  General special education, mild or

moderate  Interpreter/ASL  Low incidence disabilities/multiple

disabilities/ severe disabilities  Music therapy  Nursing  Combined studies: general education and

special education  Occupat ional therapy  Orientation & mobility  Developmental delay  Paraprofessional  Specific learning disabilities  Physical therapy  Speech/language impairment  Rehabilitation counseling  Emotional disturbance/behavioral

disorders  School counse ling  Autism  Psychology  Traumatic brain injury  Speech/language  Deafness and/or hard - of- hearing  Social work  Visual impairment and/or blindness  Therapeutic recreation  Deaf/blindness  Wo rk experience coordinator (Employment transition s pecialist)  Intellectual disability: mild/moderate  Intellectual disability: severe  Other health impairment  Physical impairment/orthopedic

impairment  Adapted physical education  Assistive technology  Bilingual special educatio n/ESL/TESOL  Early childhood/early intervention  Special education for youth in correctional

facilities  Secondary t ransitionOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 26 **3. Did the scholar take an exam or measure to demonstrate kno** **wledge and skills prior to completing this**  **OSEP fund ed**  **- training program?** 

o Yes (If selected, go to question 4 ) o No ( If selected, go to Section K ) o Don’t know (If selected, Section K ) **4 a**  **- e.**  **Please select the exam or measure the scholar took to demonstrate knowledge and skills.**  Drop Down List of Measures (See Appendix A for complete list) **5 a**  **- e.**  **Did the scholar pass this exam or measure?**

o Yes o No o Don’t know o Not applicable, our state does not set a passing score. (If selected, go to question 6

) **6 a**  **- d.**  **Did the scholar take any other exam(s) or measure(s) to demo**  **nstrate knowledge and skills prior to completing**  **this OSEP**  **- funded**  **training program?**

o Yes (If selected, repeat questions 4 to 6 until no other measures, up to 5 total) o No (If selected, go to Section K ) o Don’t know (If selected, go to Section K )OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 27 **K .**  **Service Obligation Information**  **and Exit Certification** 

## *Please **submit Exit Certification**  **.** Both grantee and scholar/oblige must complete an Exit Certification Form within the online, secure system. [See attached Exit Certification.]OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 28 **L . Information Verifica** **tion**

 **Saving and Submitting Records** : To save a record for future editing or completion, click on the SAVE button. This will create a pending record. Wh en a student has completed or exited the program and all the required information has been entered, check the box in Section L. Then, click on the SUBMIT button. Wh en the record is “submitted, ” it CANNOT be edited. To edit submitted records , please contact the DCC 

### Helpdesk. Once a record is submitted for an exited or completed scholar/obligee, the s cholar/obligee is given access to the database for input of employment information. 

# □ Yes, all information available for this scholar/obligee has been entered.OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 29 

## Appendix A: List of Measures of Knowledge and Skills The following options will be presented in a linked pair of dropdown menus. The first drop down menu will contain the ma in options. The second drop down menu will dynamically populate with the secondary list based on the current selection in the first. **Category Specific**  **As sessment of Knowledge and Skills**  Grantee specific test 

###  Comprehensive Exams



###  Defense of Dissertation 

###  Fi nal Oral Exam for Master's Degree 

###  Portfolio 

###  Practicum 

###  Supervisor evaluation 

###  Teaching Performance Assessment 

###  Thesis 

###  Other Specify _________________________ National organization test 

###  Academy fo r Certification of Vision Rehabilitation and Education Professi onals (ACVREP) Certification Exam 

###  Adapted Physical Education National Standards (APENS) Exam 

###  American Physical Therapy Association (APTA) Pediatric Specialist Certification 

###  American Sign Language Teachers Association (ASLTA) Evaluation Interview 

###  Board Cer

tified Behavior Analyst (BCBA) Exam 

###  Educational Interpreter Performance Assessment (EIPA) 

###  National Blindness Professional Certification Board (NBPCB) National Orientation and Mobility Certification Exam 

###  National Board for Professional Teaching Standards ( NBPTS) Certificate 

###  National Board for the Certification of Occupational Therapists (NBCOT) Certification 

###  National Counselor Examination (NCE) 

###  The National Council for Therapeutic Recreation Certification (NCTRC) 

###  The National Physical Therapy Examination ( NPTE) 

###  Reading Instruction Competence Assessment (RICA) 

###  Registry of Interpreters for the Deaf ( RID) Certificate of

I nterpretation and Certificate of Transliteration (CI/CT) 

###  Registry of

I nterpreters for the Deaf (RID)/National Association of the Deaf (NAD)- N ational Interpreter Certification 

###  Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) Assistive Technology Practitioner (ATP) 

###  Sign Language Proficiency Interview (SLPI) 

###  Other Specify _________________________OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 30 **Category Specific**  **As sessment of Knowledge and Skills**  PRAXIS II 

###  Aud iology



###  Early Childhood: Content Knowledge 

###  Early Childhood Education 

###  Education of Deaf and Hard of Hearing Students 

###  Education of Exceptional Students: Core Content Knowledge 

###  Education of Exceptional Students: Learning Disabilities 

###  Education of Exceptional S tudents: Mild to Moderate Disabilities 

###  Education of Exceptional Students: Severe to Profound Disabilities 

###  Education of Young Children 

###  Educational Leadership: Administration and Supervision 

###  Elementary Education: Content Area Exercises 

###  Elementary Education: Content Knowledge 

###  Elementary Education: Curriculum, Instruction, and Assessment 

###  English Language, Literacy, and Composition: Content Knowledge 

###  Fundamental Subjects: Content Knowledge 

###  Interdisciplinary Early Childhood Education 

###  Introduction to the Teaching of Reading 

###  Middle School: Content Knowledge 

###  Middle School English Language Arts 

###  Middle School Mathematics 

###  Pre - Kindergarten Education 

###  Principles of Learning and Teaching: Early Childhood 

###  Principles of Learning and Teaching: Grades K- 6 

###  Principles of Learning and Teaching: Grades 5- 9 

###  Principles of Learning and Teaching: Grades 7 - 12 

###  Reading Across the Curriculum: Elementary 

###  Reading Across the Curriculum: Secondary 

###  School Psychologist 

###  Special Education: Application of Core Principles Across Categories of Disabil ity 

###  Special Education: Knowledge - delivered Core Principles 

###  Special Education: Preschool/Early Childhood 

###  Special Education: Teaching Students with Behavioral Disorders/Emotional Disturbances 

###  Special Education: Teaching Students with Learning Disabilities 

###  Sp ecial Education: Teaching Students with Mental Retardation 

###  Speech Communication: Content Knowledge 

###  Speech - Language Pathology 

###  Teaching Foundations: Mathematics 

###  Teaching Foundations: English 

###  Teaching Speech to Students with Language Impairments 

###  Teaching Stud ents with Visual Impairments 

###  Other Specify _________________________OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 31 **Category Specific**  **As sessment of Knowledge and Skills**  State specific test 

###  Alabama (AL) o Alabama Prospective Teacher Testing Program (APTTP)/Alabama W orkKeys  Applied Mathematics  Reading for Information  Writing 

###  Arizona (AZ) o Arizona Educator Proficiency Assessment (AEPA)  Professional Knowledge: Early Childhood  Professional Knowledge: Elementary  Professional Knowledge: Secondary  Subject Knowledge: Early Childhood Education  Subject Knowledge: Elementary Education  Subject Knowledge: Special Educati on: Cross -categorical  Subject Knowledge: Special Education: Early Childhood  Subject Knowledge: Special Education: Emotional Disability  Subject Knowledge: Special Education: Hearing Impaired  Subject Knowledge: Special Education: Learning Disability  Subject Knowledge: Special Education: Mental Retardation  Subject Knowledge: Special Education: Orthopedic Impairments/Other Health Impairments  Subject Knowledge: Special Education: Severely and Profoundly Disabled  Subject Knowledge: Special Education: Speech and L anguage Impaired  Subject Knowledge: Special Education: Visually Impaired 

###  California (CA) o California Basic Educational Skills Test (CBEST) o California Subject Examinations for Teachers (CSET)  Mu ltiple Subjects I  Mu ltiple Subjects II  American Sign Language (ASL) I  American Sign Language (ASL) II  American Sign Language (ASL) III o Performance Assessment for California Teachers (PACT) o California Teaching Performance Assessment (CalTPA) o Fresno Assessment of Student Teachers (FAST)  Colorado (CO) o Program for Licensi ng Assessments for Colorado Educators (PLACE)  Administrator  Art  Basic Skills  Drama  Early Childhood EducationOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 32 **Category Specific**  **As sessment of Knowledge and Skills** 

 Early Childhood Special Education  Elementary Education  English  Health  Linguistically Diverse  Linguistically Diverse Bilingual Education  Mathemati cs  Music  Physical Education  Principal  Reading Specialist  Reading Teacher  School Counselor  School Social W orker  Science  Social Studies  Spanish  Special Education Generalist  Special Education: Severe Needs - Deaf/Hard of Hearing  Special Education: Severe Needs -Visually Impaired  Speech 

###  Florida (FL) o Florida Teacher Certification Examinations (FTCE)  General Knowledge Test (GK)  Professional Education Test (PEd)  Subject Area Examinations (SAE): Elementary Education K- 6  Subject Area Examinations (SAE): English 6 - 12  Subject Area Examinations (SAE): Exceptional Student Education K- 12  Subject Area Examinations (SAE): Hearing Impaired K- 12  Subject Area Examinations (SAE): Mathematics  Subject Area Examinations (SAE): Middle Grades English 5 - 9  Subject Area Examinations (SA E): Mathematics 5- 9  Subject Area Examinations (SAE): Prekindergarten/Primary PK- 3  Subject Area Examinations (SAE): Preschool Education Birth -Ag e 4  Subject Area Examinations (SAE): Reading K- 12  Subject Area Examinations (SAE): Speech - Language Impaired K- 12  Subject Area Examinations (SAE): Visually Impaired K- 12 o Florida Educational Leadership Examination (FELE) o Florida Registry of Interpreters for the Deaf Q uality Assurance Test 

###  Georgia (GA) o Georgia Assessments for the Certification of Educators (GACE)  Basic Skills AssessmentOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 33 **Category Specific**  **As sessment of Knowledge and Skills**  o Reading o Mathematics o Writing  Content Assessments o American Sign Language o Art Education o Birth Through Five o Biology o Early Childhood Education o Early Childhood Special Education General Curriculum o English o Mathematics o Middle Grades Language Arts o Middle Grades Mathematics o Middle Grades Reading o Reading o School Psychology o Special Education Academic Content Concentrations o Special Education Adapted Curriculum o Special Education Deaf Education o Special Education General Curriculum  Professional Pedagogy Assessment  Educational Leadership Assessment  Paraprofessional Assessment  Illinois (IL) o Assessment of Professional Teaching (APT)  Early Childhood (Birth to Grade 3)  Elementary (K- 9)  Secondary (6 - 12)  Special (K- 12) or (P-21) o Content-Area Tests  Director of Spe cial Education  Early Childhood Education  Early Childhood Special Education  Elementary/Middle Grades  English Language Arts  Learning Behavior Specialist I  Mathematics  Reading Specialist  Reading Teacher  School Psychology  School Social W orker  Special Education General Curriculum test  Speech - Language Pathologist: Nonteaching  Speech - Language Pathologist: Teaching  Teaching of Students Who Are Blind or Visually Impaired  Teaching of Students Who Are Deaf or Hard of HearingOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 34 **Category Specific**  **As sessment of Knowledge and Skills**  o Learning Behavior Specialist II (LBS II) Tests  Behavior Intervention Specialist  Bilingual Special Education Specialist  Curriculum Adaptation Specialist  Deaf- Blind Specialist  Mu ltiple Disabilities Specialist  Technology Specialist  Transition Specialist  Massachusetts (MA) o Massachusetts Test for Educator Licensure (MTEL)  Communication and Literacy Skills test  Academic (PreK

– 12) subject matter tests o Early Childhood o English o Foundations of Reading o General Curriculum o Mathematics o Mathematics (Elementary) o Mathematics (Middle School) o Middle School Humanities o Reading Specialist  Vocational Technical Literacy Skills Test  Adult Basic Education test  Michigan (MI) o Michigan Test For Teacher Certification (MTTC)  Autism Spectrum Disorder  Basic Skills  Behavioral Studies  Bilingual Education  Biology  Chemistry  Cognitive Im pairment  Communication Arts (Secondary)  Early Childhood Education  Earth/Space Science  Elementary Education  Emotional Impairment  English  English as a Second Language  Fine Arts  Guidance Counselor  Health  Health, Physical Education, and Recreation  Hearing Impa ired  History  Humanities  Integrated Science (Elementary)  Integrated Science (Secondary)  Language Arts (Elementary)OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 35 **Category Specific**  **As sessment of Knowledge and Skills** 

 Learning Disabilities  Mathematics (Elementary)  Mathematics (Secondary)  Middle Level  Music  Music Education  Physical Education  Physical or Other Health Impairment  Physical Science  Physics  Psychology  Reading  Reading Specialist  Social Studies  Speech and Language Impaired  Visual Arts Education  Visually Impaired  Minnesota (MN) o Minnesota Teacher Licensure Examinations (MTEL)  Basic Skills  Pedagogy: Early Childhood (Birth to Grade 3)  Pedagogy: Elementary (Grades K- 6)  Pedagogy: Secondary (Grades 5 - 12)  Content Area Tests: Early Childhood Education (Birth to Grade 3)  Content Area Tests: Elementary Education (Grades K- 6)  Content Area Tests: Mathematics (Grad es 5- 12)  Content Area Tests: PrePrimary (Age 3 to PreKindergarten)  Content Area Tests: Reading Teacher  Content Area Tests: Special Education Core Skills (Birth to Age 21)  Nebraska (NE) o Nebraska Commission for the Deaf and Hard of Hearing Quality Assurance Screening Test (QAST)  New Mexico (NM) o New Mexico Assessment of Teacher Basic Skills o New Mexico Assessment of T eacher Competency (Elementary OR Secondary) o New Mexico Content Knowledge Assessment in Special Education  New York (NY) o New York State Teacher Cert ification Examinations (NYSTCE)  Liberal Arts and Science Test (LAST)  Assessment of Teaching Skills (ATS -W) o Elementary o Secondary  Bilingual Education Assessment (BEA)  Content Specialty Tests (CSTs)OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 36 **Category Specific**  **As sessment of Knowledge and Skills**   American Sign Language  Biology  Blind and Visually Impaired  C hemistry  Deaf and Hard of Hearing  Earth Science  English Language Arts  English to Speakers of Other Languages (ESOL)  Health Education  Literacy  Mathematics  Mu lti - Subject  Music  Physical Education  Physics  Social Studies  Students with Disabilities  Theatre  Visua l Arts  Communication and Quantitative Skills Test (CQST)  Assessment of Teaching Skills - Performance (ATS - P)  Oklahoma (OK) o Oklahoma General Education Test (OGET) o Oklahoma Professional Teaching Examination (OPTE) o Oklahoma Subject Area Tests (OSAT)  Advanced Mathematics  Art  Biological Sciences  Blind/Visual Impairment  Chemistry  Deaf/Hard of Hearing  Early Childhood Education  Earth Science  Elementary Education Subtest 1: Reading/Language Arts  Elementary Education Subtest 2: Social Studies/Mathematics/Science/Heal th, Fitness and the Arts  Elementary Principal Specialty Test  English  English as a Second Language  Instrumental/General Music  Middle Level English  Middle Level/Intermediate Mathematics  Middle Level Principal Specialty Test  Middle Level Science  Middle Level Social Studies  Mild - Moderate Disabilities  Physical Education/Health/Safety  Physical ScienceOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 37 **Category Specific**  **As sessment of Knowledge and Skills** 

 Physics  Reading Specialist  School Counselor  School Psychologist  Secondary Principal Specialty Test  Severe - Profound/Multiple Disabilities  Speech - Language Pathologist  U.S. History/Oklahoma History/Government/Economics  Vocal/General Music  Wo rld History/Geography

 Oregon (OR) o Oregon Educator Licensure Assessments (ORELA)  Administrator  Art  Biology  Chemistry  Early Childhood Education  English Language Arts  English to Speake rs of Other Languages (ESOL)  Health  Mathematics  Middle Grades English Language Arts  Middle Grades General Science  Middle Grades Mathematics  Middle Grades Social Studies  Mu ltiple Subjects  Music  Physics  Physical Education  Protecting Student and Civil Rights in the Educational Environment  School Counselor  Special Education  Texas (TX) o Texas Examinations of Educator Standards (TExES)  Principal  Pedagogy and Professional Responsibilities 4 - 8  Generalist 4 - 8  English Language Arts and Reading/Social Studies 4 - 8  Math ematics/Science 4 - 8  Mathematics 4 - 8  Science 4 - 8  English Language Arts and Reading 4 - 8  Social Studies 4 - 8  English as a Second Language (ESL)/Generalist 4 - 8  Pedagogy and Professional Responsibilities 8 - 12  English Language Arts and Reading 8 - 12  Social Studies 8 - 12OMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 38 **Category Specific**  **As sessment of Knowledge and Skills** 

 History 8 - 12  Mathematics 8 - 12  Science 8 - 12  Physical Science 8 - 12  Life Science 8- 12  Chemistry 8 - 12  Mathematics/Physics 8 - 12  Reading Specialist  School Counselor  Educational Diagnostician  English as a Second Language (ESL) Supplemental  Health EC - 12  Phys ical Education EC - 12  Pedagogy and Professional Responsibilities EC - 12  Special Education Supplemental  Bilingual Education Supplemental  Mathematics/Physical Science/Engineering  Music EC - 12  Art EC- 12  Deaf and Hard of Hearing  Visually Impaired/Braille  American Sign Language  Bilingual Target Language Proficiency Test (BTLPT)  Bilingual Target Language Proficiency Test (BTLPT) Supplemental Guide  Generalist EC - 6  Bilingual Generalist EC -6  English as a Second Language (ESL)/Generalist EC - 6  Pedagogy and Professional Responsibilities EC - 6 o Texas Assessment of Sign Communications (TASC) o Texas Assessment of Sign Communications-American Sign Language (TASC -ASL)  Virginia (VA) o Virginia Communication and Literacy Assessment (VCLA) o Virginia Quality Assurance Screening (VQAS) o V irginia Reading Assessment (VRA)  Early/Primary prek- 3  Elementary Education prek- 6  Special Education - General Curriculum  Special Education - Hearing Impairments  Special Education -Visual Impairments  Washington (WA) o Washington Educator Skills Test- Basic (W EST- B)  Mathematics  Reading  Writing o Washington Educator Skills Test- Endorsements (W EST- E)  Bilingual Education  BiologyOMB Control Number: 1820 - 0686 Expiration: XX/XX/XXXX



### 39 **Category Specific**  **As sessment of Knowledge and Skills** 

 Chemistry  Dance  Earth and Space Science  Early Childhood Education  Early Childhood Special Education  Elementary Education  English Language Arts  English Language Learner  Health/Fitness  History  Mathematics  Middle Level Humanities  Middle Level Math  Middle Level Science  Music: Choral  Music: General (neither Choral nor Instrumental)  Music: Instrumental  Physics  Reading  Science  Social Studies  Special E ducation  Visual Arts 

###  Other Specify _________________________ Other test  Other Specify _________________________