AC Observation

 Please complete all of the following completely. (Use proper capitalization. Do Not use ALL lower case letters or abbreviations)

Application Date : - -
 Semester:       Campus Wide ID#: Social Security#:  - -
 Last Name:    First Name:          Maiden Name:
 Ethnicity:         Race1:  Race2:
 Gender:          Date of Birth:    - - Address:                


State:                   Zip:                
Home Phone:  Alternate Phone:    Fax #:             

 Level of certification:

 Teaching Field:        

Have you completed 30 hours of observation?

Note: If "Yes" stop at this point and submit the application.



 Please indicate what district and campus you would like to observe. You must spell out the district choice. Please
 type in the following format: Dallas ISD(not  DISD or Dallas), Paris ISD(not PISD or Paris). If you fail to spell
 your district choice correctly your application will not be processed.
 Note: You are not guaranteed to receive your 1st district and/or 1st campus choice.

 1st District Choice:                  Campus:

 2st District Choice:                  Campus:

 Grade Level:

Note: There may be additional districts requiring background checks; we will make you aware as we learn of them.

 I fully understand that I must submit my Criminal History Investigation form, DPS Audit form before my application will be processed.