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:                

City:                

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

 Level of certification:

 Teaching Field:        

Have you completed 30 hours of observation?

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

________________________________________________________________________________________________________________

District/Campus

 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.